Provider Demographics
NPI:1457959413
Name:GADDIS, CJ JR
Entity Type:Individual
Prefix:
First Name:CJ
Middle Name:
Last Name:GADDIS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 S PITTSBURGH ST
Mailing Address - Street 2:
Mailing Address - City:CONNELLSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15425-4003
Mailing Address - Country:US
Mailing Address - Phone:724-626-8420
Mailing Address - Fax:724-628-0898
Practice Address - Street 1:416 S PITTSBURGH ST
Practice Address - Street 2:
Practice Address - City:CONNELLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15425-4003
Practice Address - Country:US
Practice Address - Phone:724-626-8420
Practice Address - Fax:724-628-0898
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor