Provider Demographics
NPI:1467250381
Name:SUDDRETH, WHITNEY DANELLE (MA, LCMHCA, NCC)
Entity type:Individual
Prefix:MS
First Name:WHITNEY
Middle Name:DANELLE
Last Name:SUDDRETH
Suffix:
Gender:
Credentials:MA, LCMHCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1064 FOX AVE
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-6051
Mailing Address - Country:US
Mailing Address - Phone:704-402-4746
Mailing Address - Fax:704-402-4746
Practice Address - Street 1:934 DAVIE AVE
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-5302
Practice Address - Country:US
Practice Address - Phone:980-223-8930
Practice Address - Fax:704-761-6885
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-05
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA21103101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health