Healthcare Provider Details

I. General information

NPI: 1851533061
Provider Name (Legal Business Name): SOPHIA D. CAUDLE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SOPHIA D. CLAYPOOLE LPC

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 04/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 N BUCHANAN BLVD
DURHAM NC
27701-1728
US

IV. Provider business mailing address

406 N BUCHANAN BLVD
DURHAM NC
27701-1728
US

V. Phone/Fax

Practice location:
  • Phone: 919-698-7061
  • Fax:
Mailing address:
  • Phone: 919-698-7061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3539
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: