Healthcare Provider Details

I. General information

NPI: 1427002674
Provider Name (Legal Business Name): SHERRI D CAUTHEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
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: 770-743-7405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW004793
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: