Provider Demographics
NPI:1760194153
Name:SUTTON, GLENN LEDRAMA
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:LEDRAMA
Last Name:SUTTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 W RAILROAD ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-7754
Mailing Address - Country:US
Mailing Address - Phone:910-797-8981
Mailing Address - Fax:
Practice Address - Street 1:515 BLANEY CT
Practice Address - Street 2:
Practice Address - City:HOPE MILLS
Practice Address - State:NC
Practice Address - Zip Code:28348-9298
Practice Address - Country:US
Practice Address - Phone:910-797-8981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor