Provider Demographics
NPI:1508623521
Name:SUTTON, CREMATHA C
Entity Type:Individual
Prefix:
First Name:CREMATHA
Middle Name:C
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 1:5610 BRIAR OAK LN APT 507
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-2554
Mailing Address - Country:US
Mailing Address - Phone:919-866-9906
Mailing Address - Fax:
Practice Address - Street 1:1013 BULLARD CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6801
Practice Address - Country:US
Practice Address - Phone:919-583-7910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-05
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP020188101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health