Provider Demographics
NPI:1538385653
Name:SUTTERFIELD, GEORGE KIM (PHD, MFT)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:KIM
Last Name:SUTTERFIELD
Suffix:
Gender:M
Credentials:PHD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 DONAHUE ST
Mailing Address - Street 2:UNIT 2
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-1725
Mailing Address - Country:US
Mailing Address - Phone:619-762-9300
Mailing Address - Fax:619-272-0132
Practice Address - Street 1:1055 DONAHUE ST
Practice Address - Street 2:UNIT 2
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-1725
Practice Address - Country:US
Practice Address - Phone:619-762-9300
Practice Address - Fax:619-272-0132
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC18089106H00000X
CAMFC 18089106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist