Provider Demographics
NPI:1508038571
Name:DUTTON, LOIS ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:LOIS
Middle Name:ANN
Last Name:DUTTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 BRIDLEWOOD LN SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-7376
Mailing Address - Country:US
Mailing Address - Phone:404-792-3566
Mailing Address - Fax:
Practice Address - Street 1:2605 BRIDLEWOOD LN SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-7376
Practice Address - Country:US
Practice Address - Phone:404-792-3566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-30
Last Update Date:2008-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN114445101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)