Provider Demographics
NPI:1376317420
Name:SUTTON, MARTHA DELLENEY
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:DELLENEY
Last Name:SUTTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 GREGG ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-3528
Mailing Address - Country:US
Mailing Address - Phone:803-786-1844
Mailing Address - Fax:803-939-2646
Practice Address - Street 1:1408 GREGG ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-3528
Practice Address - Country:US
Practice Address - Phone:803-786-1844
Practice Address - Fax:803-939-2646
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC570984185251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health