Provider Demographics
NPI:1770799082
Name:SUTTON, BRENDA ALETHEA (MHP)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:ALETHEA
Last Name:SUTTON
Suffix:
Gender:F
Credentials:MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 PLANT AVENUE SUITE J
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501
Mailing Address - Country:US
Mailing Address - Phone:912-283-6612
Mailing Address - Fax:
Practice Address - Street 1:315 PLANT AVE
Practice Address - Street 2:SUITE J BOX 10
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-3743
Practice Address - Country:US
Practice Address - Phone:912-283-6612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker