Provider Demographics
NPI:1154781862
Name:SUTTON, KENNETH (MHS, BS, CAADC, LPC)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:SUTTON
Suffix:
Gender:M
Credentials:MHS, BS, CAADC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 RADCLIFFE DR
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-5459
Mailing Address - Country:US
Mailing Address - Phone:718-503-1309
Mailing Address - Fax:
Practice Address - Street 1:419 RADCLIFFE DR
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-5459
Practice Address - Country:US
Practice Address - Phone:718-503-1309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-24
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008745101YM0800X, 101YA0400X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)