Provider Demographics
NPI:1548936495
Name:HUTTO, VIRGINIA MCCORKLE (LISW-CP)
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:MCCORKLE
Last Name:HUTTO
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 GUNTER CIR
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016-9191
Mailing Address - Country:US
Mailing Address - Phone:803-269-0859
Mailing Address - Fax:
Practice Address - Street 1:240 GUNTER CIR
Practice Address - Street 2:
Practice Address - City:BLYTHEWOOD
Practice Address - State:SC
Practice Address - Zip Code:29016-9191
Practice Address - Country:US
Practice Address - Phone:803-269-0859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC57111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty