Provider Demographics
NPI:1932402427
Name:HARRIS-HUTCHINSON, CAROLYN DIANE (LICSW)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:DIANE
Last Name:HARRIS-HUTCHINSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3202 CULVER ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-4515
Mailing Address - Country:US
Mailing Address - Phone:240-413-3116
Mailing Address - Fax:
Practice Address - Street 1:10905 FORT WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-5843
Practice Address - Country:US
Practice Address - Phone:240-413-3116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-06
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3028741041C0700X
MD092701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical