Provider Demographics
NPI:1427839745
Name:SUTTON, ALICIA DAWN (MS, QP, LCAS-A)
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:DAWN
Last Name:SUTTON
Suffix:
Gender:F
Credentials:MS, QP, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:GIBSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27249-2914
Mailing Address - Country:US
Mailing Address - Phone:336-430-9674
Mailing Address - Fax:
Practice Address - Street 1:811 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:GIBSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:27249-2914
Practice Address - Country:US
Practice Address - Phone:336-430-9674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28651101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)