Provider Demographics
NPI:1073740338
Name:SUCOREE ENTERPRISE, PLLC
Entity Type:Organization
Organization Name:SUCOREE ENTERPRISE, PLLC
Other - Org Name:SUCOREE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUZETTE
Authorized Official - Middle Name:GENETHA
Authorized Official - Last Name:COTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-265-1894
Mailing Address - Street 1:609 RICHLANDS HWY STE 8
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-3606
Mailing Address - Country:US
Mailing Address - Phone:910-265-1894
Mailing Address - Fax:
Practice Address - Street 1:609 RICHLANDS HWY STE 8
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-3606
Practice Address - Country:US
Practice Address - Phone:910-265-1894
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-14
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 302F00000X
NC1676251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No302F00000XManaged Care OrganizationsExclusive Provider Organization