Provider Demographics
NPI:1538564133
Name:SUTHERLAND, THOMAS (MA, LPC, NCC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:SUTHERLAND
Suffix:
Gender:M
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33300 FIVE MILE RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-3093
Mailing Address - Country:US
Mailing Address - Phone:734-522-0280
Mailing Address - Fax:
Practice Address - Street 1:33300 FIVE MILE RD STE 208
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-3077
Practice Address - Country:US
Practice Address - Phone:734-522-0280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-27
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401017263101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor