Provider Demographics
NPI:1114802469
Name:SONDERICKER, MICHAEL JEFFREY (LCASA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JEFFREY
Last Name:SONDERICKER
Suffix:
Gender:M
Credentials:LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3710 UNIVERSITY DR STE 100
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-6208
Mailing Address - Country:US
Mailing Address - Phone:919-906-4390
Mailing Address - Fax:919-287-2707
Practice Address - Street 1:3710 UNIVERSITY DR STE 100
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6208
Practice Address - Country:US
Practice Address - Phone:919-906-4390
Practice Address - Fax:919-287-2707
Is Sole Proprietor?:No
Enumeration Date:2025-08-06
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1281293101YA0400X, 101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool