Provider Demographics
NPI:1376183632
Name:SUDDERTH, JACQUELINE MALOCH (MSW,LCSWA)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:MALOCH
Last Name:SUDDERTH
Suffix:
Gender:F
Credentials:MSW,LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 CENTRAL AVE STE C
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-2451
Mailing Address - Country:US
Mailing Address - Phone:828-393-0902
Mailing Address - Fax:
Practice Address - Street 1:77 CENTRAL AVE STE C
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2451
Practice Address - Country:US
Practice Address - Phone:828-393-0902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-14
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-26098101YA0400X
NCP0210891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)