Individual
ABIGAIL BRIANNA SUTHERLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
924 EMERALD BAY RD STE A2, SOUTH LAKE TAHOE, CA 96150-6434
(909) 292-0240
Mailing address
1881 BUSINESS CENTER DR, SAN BERNARDINO, CA 92408-3465
(909) 277-7339
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
112368
CA
104100000X
Social Worker
—
CA
1041C0700X
Clinical Social Worker
Primary
—
CA
106S00000X
Behavior Technician
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
05/26/2020
Last updated
10/28/2024
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