Provider Demographics
NPI:1265817530
Name:THE SUTHERLAND CENTER, LLC
Entity Type:Organization
Organization Name:THE SUTHERLAND CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SUTHERLAND
Authorized Official - Suffix:JR
Authorized Official - Credentials:ED D, LPC, NCC
Authorized Official - Phone:770-853-6372
Mailing Address - Street 1:PO BOX 6686
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30154-0029
Mailing Address - Country:US
Mailing Address - Phone:770-853-6372
Mailing Address - Fax:888-399-2597
Practice Address - Street 1:4200 RESERVE HILL XING
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-5188
Practice Address - Country:US
Practice Address - Phone:770-853-6372
Practice Address - Fax:888-399-2597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004159251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health