Provider Demographics
NPI:1508867110
Name:SUTTON, PATTI (LCSW)
Entity Type:Individual
Prefix:
First Name:PATTI
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 1:330 W BRAMBLETON AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1325
Mailing Address - Country:US
Mailing Address - Phone:757-640-0400
Mailing Address - Fax:757-626-3318
Practice Address - Street 1:330 W BRAMBLETON AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1325
Practice Address - Country:US
Practice Address - Phone:757-640-0400
Practice Address - Fax:757-626-3318
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904002557104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
253666OtherCOM PSYCH