Provider Demographics
NPI:1659171718
Name:SUTTON, CAROL RENEE
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:RENEE
Last Name:SUTTON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2604 ROSEBAY DR
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17408-4071
Mailing Address - Country:US
Mailing Address - Phone:717-418-4307
Mailing Address - Fax:717-888-9170
Practice Address - Street 1:100 N CAMERON ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17101-2424
Practice Address - Country:US
Practice Address - Phone:717-418-4307
Practice Address - Fax:717-888-9170
Is Sole Proprietor?:No
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA227107101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)