Provider Demographics
NPI:1457939076
Name:NICOLE SUTTON BEHAVIORAL THERAPY
Entity type:Organization
Organization Name:NICOLE SUTTON BEHAVIORAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:N
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCAS
Authorized Official - Phone:910-783-5636
Mailing Address - Street 1:360 WHIPPOORWILL LN
Mailing Address - Street 2:
Mailing Address - City:PINEBLUFF
Mailing Address - State:NC
Mailing Address - Zip Code:28373-5502
Mailing Address - Country:US
Mailing Address - Phone:910-783-5636
Mailing Address - Fax:
Practice Address - Street 1:750C NW BROAD ST
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-4102
Practice Address - Country:US
Practice Address - Phone:910-585-6091
Practice Address - Fax:910-246-1681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-02
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1316232101Medicaid