Provider Demographics
NPI:1396393187
Name:SUCHOCKI, J BRIAN (MED)
Entity Type:Individual
Prefix:
First Name:J
Middle Name:BRIAN
Last Name:SUCHOCKI
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 CARLTON RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-5930
Mailing Address - Country:US
Mailing Address - Phone:434-328-0793
Mailing Address - Fax:
Practice Address - Street 1:709 W MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-4570
Practice Address - Country:US
Practice Address - Phone:434-326-4577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor