Provider Demographics
NPI:1801460985
Name:SUTHERLAND, ANDREW C (RADT)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:C
Last Name:SUTHERLAND
Suffix:
Gender:M
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 1/2 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-6036
Mailing Address - Country:US
Mailing Address - Phone:092-417-9262
Mailing Address - Fax:
Practice Address - Street 1:1530 3RD ST STE 111
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-2501
Practice Address - Country:US
Practice Address - Phone:916-884-0579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-13
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1424280421101YA0400X
CA136782101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)