Healthcare Provider Details

I. General information

NPI: 1053224808
Provider Name (Legal Business Name): STEPHANIE EDMONDS CAUDLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 CAROLINA ST STE 114
GREENSBORO NC
27401-1090
US

IV. Provider business mailing address

8204 HUNTERS DR
GREENSBORO NC
27455-8330
US

V. Phone/Fax

Practice location:
  • Phone: 336-542-2060
  • Fax:
Mailing address:
  • Phone: 336-707-9944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP024648
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: