Provider Demographics
NPI:1275838559
Name:SUTTON, DIANNA LYNN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DIANNA
Middle Name:LYNN
Last Name:SUTTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 WILMETTE AVE APT 413
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-9515
Mailing Address - Country:US
Mailing Address - Phone:386-341-3209
Mailing Address - Fax:
Practice Address - Street 1:875 WILMETTE AVE APT 413
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-9515
Practice Address - Country:US
Practice Address - Phone:386-341-3209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW98891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical