Provider Demographics
NPI:1538326129
Name:SUDBERRY, AUDREY M (LPC)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:M
Last Name:SUDBERRY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26241 LAKE SHORE BLVD
Mailing Address - Street 2:#2164
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-1177
Mailing Address - Country:US
Mailing Address - Phone:216-923-0823
Mailing Address - Fax:
Practice Address - Street 1:1991 LEE RD
Practice Address - Street 2:#10 ABEL COUNSELING & ASSOCS
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-1177
Practice Address - Country:US
Practice Address - Phone:216-923-0823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC05000407101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health