Doctor Name: | ALVIN C SUTHERLAND |
NPI Number: | 1023298908 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LCSW |
License Number: | LPC004159 |
Business Practice Address: | 332 Shawnee Indian Ln Suwanee, GA - 300246531 |
Business Phone Number: | 3373195476 |
Business Fax Number: | |
Mailing Address: | 4200 Reserve Hill Xing, DOUGLASVILLE |
State: | GA |
Postal Code: | 301355188 |
Phone Number: | 7708536372 |
Fax Number: | |
NPI Enumeration Date: | 11/08/2007 |
NPI Last Update Date: | 11/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | LPC004159 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |