Healthcare Provider Details

I. General information

NPI: 1144710229
Provider Name (Legal Business Name): CAUTHEN COUNSELING AND CONSULTING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2018
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10130 MALLARD CREEK RD STE 300
CHARLOTTE NC
28262-6001
US

IV. Provider business mailing address

10130 MALLARD CREEK RD STE 300
CHARLOTTE NC
28262-6001
US

V. Phone/Fax

Practice location:
  • Phone: 704-850-6479
  • Fax: 704-603-3011
Mailing address:
  • Phone: 704-433-5267
  • Fax: 704-603-3011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC005932
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHANA N. CAUTHEN
Title or Position: OWNER
Credential: LCSW
Phone: 704-433-5267