Provider Demographics
NPI:1437495454
Name:TUTTY, SUSAN E (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:TUTTY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:E
Other - Last Name:TUTTY LLC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1842 INDEPENDENCE SQ STE D
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-5168
Mailing Address - Country:US
Mailing Address - Phone:678-982-6189
Mailing Address - Fax:404-393-8389
Practice Address - Street 1:1842 INDEPENDENCE SQ
Practice Address - Street 2:STE D
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-5168
Practice Address - Country:US
Practice Address - Phone:678-982-6189
Practice Address - Fax:404-393-8389
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-19
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0043671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003176377AMedicaid