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General NPI Number Information
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NPI Number | 1578619763
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Entity Type | Individual
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Provider Name | LAWRENCE E. SUTTON L.P.C.
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Gender | Male
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Dates
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Enumeration Date | 01/28/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 12890 HARBOR DR
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City | WOODBRIDGE
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State | VA
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Zip | 22192-2921
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Country | US
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Telephone | 703-490-3497
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Fax | 703-491-7662
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Provider Business Mailing Address
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Address Line | 12481 CRICKET LN
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City | WOODBRIDGE
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State | VA
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Zip | 22192-5236
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Country | US
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Telephone | 703-494-8343
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Fax | 703-491-7662
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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 | 0701001956
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License Number State | VA
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