Healthcare Provider Details

I. General information

NPI: 1679142632
Provider Name (Legal Business Name): TAMEKA LA'SHUN'TEL SUTTON MSW, LCSW, CCTP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2708 BISHOPTON PL
CHARLOTTE NC
28216-9612
US

IV. Provider business mailing address

2708 BISHOPTON PL
CHARLOTTE NC
28216-9612
US

V. Phone/Fax

Practice location:
  • Phone: 980-301-3803
  • Fax:
Mailing address:
  • Phone: 980-301-3803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP0161100
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP016100
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberP016100
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: