Provider Demographics
NPI:1508339953
Name:SUTHERLAND-SMITH, CURISSA (PHD, LCPC, CRC, NCC)
Entity type:Individual
Prefix:DR
First Name:CURISSA
Middle Name:
Last Name:SUTHERLAND-SMITH
Suffix:
Gender:F
Credentials:PHD, LCPC, CRC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3096
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60303-3096
Mailing Address - Country:US
Mailing Address - Phone:773-738-5906
Mailing Address - Fax:
Practice Address - Street 1:4800 W CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60651-3226
Practice Address - Country:US
Practice Address - Phone:773-826-9925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-08
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.015897101Y00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program