Provider Demographics
NPI:1932904554
Name:SUDDUTH, MARQUIESE DEJON MALIK
Entity type:Individual
Prefix:
First Name:MARQUIESE
Middle Name:DEJON MALIK
Last Name:SUDDUTH
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 1:3527 PINEY RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-9781
Mailing Address - Country:US
Mailing Address - Phone:828-334-0758
Mailing Address - Fax:
Practice Address - Street 1:3527 PINEY RD
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-9781
Practice Address - Country:US
Practice Address - Phone:828-334-0758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-18
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCRBT-24-353678106S00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician