Doctor Name: | ALICE SUDDUTH |
NPI Number: | 1205812617 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 3856 |
Business Practice Address: | 20823 N Main St Suite 113 Cornelius, NC - 280318206 |
Business Phone Number: | 7048958447 |
Business Fax Number: | 7048958494 |
Mailing Address: | 20823 N Main St, Suite 113 CORNELIUS |
State: | NC |
Postal Code: | 280318206 |
Phone Number: | 7048958447 |
Fax Number: | 7048958494 |
NPI Enumeration Date: | 12/16/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 3856 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |