Provider Demographics
NPI:1396098794
Name:SUTTON, KATHY KATRINA (EDD)
Entity type:Individual
Prefix:DR
First Name:KATHY
Middle Name:KATRINA
Last Name:SUTTON
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 LANG PL NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-3026
Mailing Address - Country:US
Mailing Address - Phone:202-409-4938
Mailing Address - Fax:
Practice Address - Street 1:1750 LANG PL NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-3026
Practice Address - Country:US
Practice Address - Phone:202-409-4938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-23
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC8933101YP2500X
DCPRC14456101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional