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1356924682 NPI number — DEDRICK R GADDY LCSW-A

NPI Number: 1356924682
Health Care Provider/Practitioner: DEDRICK R GADDY LCSW-A

Information about “1356924682” NPI (DEDRICK R GADDY LCSW-A) exists in 1356924682 in HTML format HTML  |  1356924682 in plain Text format TXT  |  1356924682 in PDF (Portable Document Format) PDF  |  1356924682 in an XML format XML  formats.

NPI Number : 1356924682 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1356924682",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GADDY",
    "FirstName": "DEDRICK",
    "MiddleName": "R",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LCSW-A",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2421 GLADE MILL CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FUQUAY VARINA",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "27526-3525",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "919-628-8763",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "190 ROSEWOOD CENTRE DR STE 100",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HOLLY SPRINGS",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "27540-7628",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "919-851-1527",
    "PracticeLocationAddressFaxNumber": "919-851-3555",
    "EnumerationDate": "05/04/2021",
    "LastUpdateDate": "06/03/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "1041C0700X",
        "TaxonomyName": "Clinical Social Worker",
        "LicenseNumber": "PO15542",
        "LicenseNumberStateCode": "NC",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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