Provider Demographics
NPI:1376313304
Name:SUTTON, LISA (CDCA, QMHS ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:SUTTON
Suffix:
Gender:F
Credentials:CDCA, QMHS ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24865 US HIGHWAY 23 S STE A
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-9189
Mailing Address - Country:US
Mailing Address - Phone:614-219-9394
Mailing Address - Fax:
Practice Address - Street 1:24865 US HIGHWAY 23 S STE A
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-9189
Practice Address - Country:US
Practice Address - Phone:614-219-9394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator