Healthcare Provider Details

I. General information

NPI: 1033033667
Provider Name (Legal Business Name): SULA COTTMAN CARLTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5514 LOCUST ST
PHILADELPHIA PA
19139-3929
US

IV. Provider business mailing address

5514 LOCUST ST
PHILADELPHIA PA
19139-3929
US

V. Phone/Fax

Practice location:
  • Phone: 267-499-8226
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC002093
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: