Provider Demographics
NPI:1447340583
Name:SUDDETH, JOE ALLEN
Entity type:Individual
Prefix:MR
First Name:JOE
Middle Name:ALLEN
Last Name:SUDDETH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 W UNION ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-3729
Mailing Address - Country:US
Mailing Address - Phone:828-439-2328
Mailing Address - Fax:828-439-2332
Practice Address - Street 1:304 W UNION ST
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-3729
Practice Address - Country:US
Practice Address - Phone:828-439-2328
Practice Address - Fax:828-439-2332
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1132103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical