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General NPI Number Information
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NPI Number | 1902253511
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Entity Type | Organization
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Legal Business Name | SUTTER COMPASS THERAPY, LLC
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Dates
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Enumeration Date | 05/24/2016
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Last Update Date | 05/24/2016
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Provider Practice Location Address
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Address Line | 2350 CLAYTON ST
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City | MACON
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State | GA
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Zip | 31204-3045
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Country | US
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Telephone | 478-238-0462
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Fax | 478-257-8247
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Provider Business Mailing Address
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Address Line | 2350 CLAYTON ST
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City | MACON
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State | GA
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Zip | 31204-3045
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Country | US
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Telephone | 478-238-0462
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Fax | 478-257-8247
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Authorized Official
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Title or Position | OWNER, THERAPIST, SOCIAL WORKER
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Name | MR. KRISTOPHER M SUTTER
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Credential | LCSW, LISW-S, MSW
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Telephone | 740-591-1741
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW005790
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License Number State | GA
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