Provider Demographics
NPI:1699153403
Name:SUTTON, CATHY (LCSW)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:SUTTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3617 BRASELTON HWY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-4667
Mailing Address - Country:US
Mailing Address - Phone:217-474-6892
Mailing Address - Fax:
Practice Address - Street 1:3617 BRASELTON HWY
Practice Address - Street 2:SUITE 104
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-4667
Practice Address - Country:US
Practice Address - Phone:217-474-6892
Practice Address - Fax:770-783-8927
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0054891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical