Healthcare Provider Details

I. General information

NPI: 1003455056
Provider Name (Legal Business Name): CAUTHEN COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2019
Last Update Date: 12/24/2019
Certification Date: 12/24/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 CLAIRMONT RD STE 105
DECATUR GA
30033-3438
US

IV. Provider business mailing address

750 E LAKE DR APT 12
DECATUR GA
30030-4906
US

V. Phone/Fax

Practice location:
  • Phone: 770-743-7405
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHERRI D CAUTHEN
Title or Position: OWNER
Credential:
Phone: 770-743-7405