Provider Demographics
NPI:1184867681
Name:SUTHERLAND, LOUISA ANN MARIE (MS)
Entity type:Individual
Prefix:MRS
First Name:LOUISA
Middle Name:ANN MARIE
Last Name:SUTHERLAND
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 SPARTAN DR
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-3468
Mailing Address - Country:US
Mailing Address - Phone:407-331-8002
Mailing Address - Fax:407-331-8659
Practice Address - Street 1:150 SPARTAN DR
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-3468
Practice Address - Country:US
Practice Address - Phone:407-331-8002
Practice Address - Fax:407-331-8659
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health