Provider Demographics
NPI:1871254920
Name:STUKES, GEROD (BBS, ACC, APM, CSAC,)
Entity Type:Individual
Prefix:
First Name:GEROD
Middle Name:
Last Name:STUKES
Suffix:
Gender:M
Credentials:BBS, ACC, APM, CSAC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1258 HOLLAND RD
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-6313
Mailing Address - Country:US
Mailing Address - Phone:175-780-9477
Mailing Address - Fax:757-353-4451
Practice Address - Street 1:1258 HOLLAND RD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-6313
Practice Address - Country:US
Practice Address - Phone:757-809-4771
Practice Address - Fax:757-353-4451
Is Sole Proprietor?:No
Enumeration Date:2021-12-31
Last Update Date:2021-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3108101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)