Provider Demographics
NPI:1033488531
Name:SUTTER, KIM ELIZABETH (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:ELIZABETH
Last Name:SUTTER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6308 OLD HARFORD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214-1241
Mailing Address - Country:US
Mailing Address - Phone:410-254-9666
Mailing Address - Fax:
Practice Address - Street 1:6308 OLD HARFORD RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214-1241
Practice Address - Country:US
Practice Address - Phone:410-254-9666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD4165101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional