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General NPI Number Information
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NPI Number | 1104762046
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Entity Type | Individual
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Provider Name | GRACE LYNN SUTTERA M.ED., LAC
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Gender | Female
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Dates
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Enumeration Date | 04/24/2026
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Last Update Date | 04/24/2026
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Provider Practice Location Address
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Address Line | 42 DELSEA DR S
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City | GLASSBORO
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State | NJ
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Zip | 08028-2621
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Country | US
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Telephone | 844-422-3632
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Fax |
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Provider Business Mailing Address
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Address Line | 124 VERMONT AVE
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City | VILLAS
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State | NJ
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Zip | 08251-1549
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Country | US
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Telephone | 609-827-0271
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 3071687
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License Number State | NJ
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