Provider Demographics
NPI:1730670902
Name:SADTLER, MICHAEL (LCASA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:SADTLER
Suffix:
Gender:M
Credentials:LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 SIERRA TRL
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28390-8979
Mailing Address - Country:US
Mailing Address - Phone:910-723-5810
Mailing Address - Fax:910-323-1355
Practice Address - Street 1:804 STAMPER RD STE 101
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303
Practice Address - Country:US
Practice Address - Phone:910-323-2875
Practice Address - Fax:910-323-1355
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24322101YA0400X
NCP0126551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)