Provider Demographics
NPI:1467109801
Name:SUTTON, TAMMY (LCSW)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
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 1:3363 SILKWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-9579
Mailing Address - Country:US
Mailing Address - Phone:850-288-1872
Mailing Address - Fax:
Practice Address - Street 1:600 UNIVERSITY OFFICE BLVD STE 13A
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-6247
Practice Address - Country:US
Practice Address - Phone:850-449-0589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-06
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW195441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical