Provider Demographics
NPI:1093076655
Name:SUTTER, JULIE ANN (LCSW, LADAC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:SUTTER
Suffix:
Gender:F
Credentials:LCSW, LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E BROADWAY AVE STE 413
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-5754
Mailing Address - Country:US
Mailing Address - Phone:865-924-3179
Mailing Address - Fax:
Practice Address - Street 1:200 E BROADWAY AVE STE 413
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5754
Practice Address - Country:US
Practice Address - Phone:865-924-3179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDC0000001122101YA0400X
TNLSW00000058541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)