Healthcare Provider Details

I. General information

NPI: 1740988534
Provider Name (Legal Business Name): MONICA DEANNE HUTCHINSON SUDRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2023
Last Update Date: 02/21/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ENCOMPASS COMMUNITY SERVICES 380 ENCINAL STREET, STE. 200
SANTA CRUZ CA
95060
US

IV. Provider business mailing address

701 GIBSON DR APT 2116
ROSEVILLE CA
95678-5734
US

V. Phone/Fax

Practice location:
  • Phone: 831-469-1700
  • Fax:
Mailing address:
  • Phone: 831-214-6608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number13573
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: