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General NPI Number Information
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NPI Number | 1073740338
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Entity Type | Organization
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Legal Business Name | SUCOREE ENTERPRISE, PLLC
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Dates
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Enumeration Date | 06/14/2009
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Last Update Date | 07/25/2012
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Provider Practice Location Address
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Address Line | 609 RICHLANDS HWY STE 8
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City | JACKSONVILLE
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State | NC
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Zip | 28540-3606
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Country | US
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Telephone | 910-265-1894
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Fax |
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Provider Business Mailing Address
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Address Line | 609 RICHLANDS HWY STE 8
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City | JACKSONVILLE
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State | NC
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Zip | 28540-3606
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Country | US
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Telephone | 910-265-1894
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SUZETTE GENETHA COTTER
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Credential |
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Telephone | 910-265-1894
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1676
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License Number State | NC
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