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General NPI Number Information
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NPI Number | 1457781536
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Entity Type | Individual
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Provider Name | GREGORY SUDDRETH
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Gender | Male
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Dates
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Enumeration Date | 11/26/2013
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 106 3RD AVE NE
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City | HICKORY
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State | NC
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Zip | 28601-5014
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Country | US
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Telephone | 828-322-9130
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Fax | 828-322-7890
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Provider Business Mailing Address
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Address Line | 1617 16TH ST NE
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City | HICKORY
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State | NC
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Zip | 28601-2815
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Country | US
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Telephone | 828-461-2822
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 3579
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 10489
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License Number State | NC
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