Provider Demographics
NPI:1649713520
Name:SUTTON, COLIN (LCSW-C, LICSW)
Entity type:Individual
Prefix:
First Name:COLIN
Middle Name:
Last Name:SUTTON
Suffix:
Gender:M
Credentials:LCSW-C, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3829 SWAN HOUSE CT
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-2076
Mailing Address - Country:US
Mailing Address - Phone:240-418-8697
Mailing Address - Fax:
Practice Address - Street 1:3829 SWAN HOUSE CT
Practice Address - Street 2:
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-2076
Practice Address - Country:US
Practice Address - Phone:240-418-8697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD173461041C0700X
DCLC500810141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical