Healthcare Provider Details

I. General information

NPI: 1912598517
Provider Name (Legal Business Name): AMBER SUTTON LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 TWINING ST BLDG 760
MAXWELL AFB AL
36112-6027
US

IV. Provider business mailing address

300 TWINING ST BLDG 760
MAXWELL AFB AL
36112-6027
US

V. Phone/Fax

Practice location:
  • Phone: 334-953-5200
  • Fax: 334-953-8607
Mailing address:
  • Phone: 334-953-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4346C
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: