Provider Demographics
NPI:1316472830
Name:SUTTON, MAXINE (MSW, MSTT, LCSW-A)
Entity type:Individual
Prefix:
First Name:MAXINE
Middle Name:
Last Name:SUTTON
Suffix:
Gender:F
Credentials:MSW, MSTT, LCSW-A
Other - Prefix:
Other - First Name:MAX
Other - Middle Name:
Other - Last Name:SUTTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, MSTT, LCSW
Mailing Address - Street 1:600 LYNNDALE COURT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858
Mailing Address - Country:US
Mailing Address - Phone:252-353-8001
Mailing Address - Fax:252-353-5559
Practice Address - Street 1:600 LYNNDALE CT
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5443
Practice Address - Country:US
Practice Address - Phone:252-353-8001
Practice Address - Fax:252-353-5559
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-21
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0129031041C0700X
NCP0109141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical