Provider Demographics
NPI:1861514366
Name:SUTPHIN, PHYLLIS (LPC)
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:SUTPHIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 HARMON LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-3472
Mailing Address - Country:US
Mailing Address - Phone:336-993-3770
Mailing Address - Fax:336-993-0277
Practice Address - Street 1:110 HARMON LN
Practice Address - Street 2:SUITE B
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-3472
Practice Address - Country:US
Practice Address - Phone:336-993-3770
Practice Address - Fax:336-993-0277
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3571101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional