Provider Demographics
NPI:1861830911
Name:SUTTER, NICHOLAS MICHAEL (LMSW)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:MICHAEL
Last Name:SUTTER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 KNIGHTS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37803-1953
Mailing Address - Country:US
Mailing Address - Phone:865-983-8914
Mailing Address - Fax:
Practice Address - Street 1:3841 BRICKWAY BLVD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-8226
Practice Address - Country:US
Practice Address - Phone:707-569-2300
Practice Address - Fax:707-569-2383
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN96941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical