Provider Demographics
NPI:1740061720
Name:CRADLE, JOHN ALFRED SR (MDIV)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ALFRED
Last Name:CRADLE
Suffix:SR
Gender:M
Credentials:MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 N MANGUM ST STE 400
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-2260
Mailing Address - Country:US
Mailing Address - Phone:919-683-1607
Mailing Address - Fax:
Practice Address - Street 1:800 N MANGUM ST STE 400
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-2260
Practice Address - Country:US
Practice Address - Phone:919-683-1607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty