MEDICARE: DR. LAWRENCE E. SUTTON L.P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	0701001956	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	025436	OTHER	VA	VALUE OPTIONS
3	085981	OTHER	VA	ANTHEM
4	70058000	OTHER	VA	MAGELLAN
5	B619	OTHER	VA	CARE FIRST

General Provider Information

NPI Number	:	1578619763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE E. SUTTON L.P.C.

Provider Business Mailing Address
First Line	:	12481 CRICKET LN
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22192-5236
Country	:	US
Telephone Number	:	703-494-8343
Fax Number	:	703-491-7662

Provider Business Practice Location Address
First Line	:	12890 HARBOR DR
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22192-2921
Country	:	US
Telephone Number	:	703-490-3497
Fax Number	:	703-491-7662

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2007
Last Update Date	:	07/08/2007

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