Provider Demographics
NPI:1780338087
Name:SUTTON, ANDREA (ADT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:SUTTON
Suffix:
Gender:F
Credentials:ADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 LITTLESTOWN PIKE STE A1
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-3042
Mailing Address - Country:US
Mailing Address - Phone:410-386-1180
Mailing Address - Fax:410-386-1185
Practice Address - Street 1:1004 LITTLESTOWN PIKE STE A1
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-3042
Practice Address - Country:US
Practice Address - Phone:410-386-1180
Practice Address - Fax:410-386-1185
Is Sole Proprietor?:No
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDADT2498101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDADT2498OtherMARYLAND BOARD OF COUNSELORS AND THERAPISTS