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Provider Information for 1659553832


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Mr. JERRY MARVIN UTT LCSW


Sex: Male

NPI: 1659553832
Last Updated: 2007-11-29
Certification Date:

Details

NameValue
NPI1659553832
Enumeration Date2007-11-29
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address 301 EAST PARKER STREET
KINGS MOUNTAIN, NC 28086
United States

Phone: 704-730-1591 | Fax:
 
Primary Practice Address 301 EAST PARKER STREET
KINGS MOUNTAIN, NC 28086
United States

Phone: 704-730-1591 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 1041C0700X - Social Worker - ClinicalNCC000778