Healthcare Provider Details

I. General information

NPI: 1295306231
Provider Name (Legal Business Name): CAITLIN HURLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2021
Last Update Date: 07/09/2021
Certification Date: 07/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1878 WESTON LN
TUCKER GA
30084-5500
US

IV. Provider business mailing address

1427 E 48TH ST
SAVANNAH GA
31404-4007
US

V. Phone/Fax

Practice location:
  • Phone: 404-860-0840
  • Fax:
Mailing address:
  • Phone: 414-336-5661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: