Provider Demographics
NPI:1912568700
Name:SUTHERLIN, JENNIFER A (LCMHC; LCAS)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:A
Last Name:SUTHERLIN
Suffix:
Gender:F
Credentials:LCMHC; LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:115 WOODY LN
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-6183
Mailing Address - Country:US
Mailing Address - Phone:828-707-7529
Mailing Address - Fax:980-323-9500
Practice Address - Street 1:70 WOODFIN PL STE 417
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2441
Practice Address - Country:US
Practice Address - Phone:828-515-4223
Practice Address - Fax:828-515-4223
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-25617101YA0400X, 101YA0400X
NC15526101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)