Provider Demographics
NPI:1689032799
Name:SUTHERLAND, LAUREN (MS)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:SUTHERLAND
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3838 WHITEDOVE DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33812-4358
Mailing Address - Country:US
Mailing Address - Phone:863-529-7463
Mailing Address - Fax:
Practice Address - Street 1:3838 WHITEDOVE DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33812-4358
Practice Address - Country:US
Practice Address - Phone:863-529-7463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)