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General NPI Number Information
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NPI Number | 1265817530
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Entity Type | Organization
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Legal Business Name | THE SUTHERLAND CENTER, LLC
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Dates
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Enumeration Date | 07/28/2015
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Last Update Date | 07/28/2015
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Provider Practice Location Address
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Address Line | 4200 RESERVE HILL XING
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-5188
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Country | US
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Telephone | 770-853-6372
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Fax | 888-399-2597
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Provider Business Mailing Address
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Address Line | PO BOX 6686
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City | DOUGLASVILLE
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State | GA
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Zip | 30154-0029
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Country | US
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Telephone | 770-853-6372
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Fax | 888-399-2597
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALVIN C SUTHERLAND JR.
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Credential | ED. D, LPC, NCC
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Telephone | 770-853-6372
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LPC004159
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License Number State | GA
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