Provider Demographics
NPI:1356924682
Name:GADDY, DEDRICK R (LCSW-A)
Entity type:Individual
Prefix:
First Name:DEDRICK
Middle Name:R
Last Name:GADDY
Suffix:
Gender:M
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2421 GLADE MILL CT
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-3525
Mailing Address - Country:US
Mailing Address - Phone:919-628-8763
Mailing Address - Fax:
Practice Address - Street 1:190 ROSEWOOD CENTRE DR STE 100
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-7628
Practice Address - Country:US
Practice Address - Phone:919-851-1527
Practice Address - Fax:919-851-3555
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPO155421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical