Healthcare Provider Details

I. General information

NPI: 1023365756
Provider Name (Legal Business Name): CAROLYN A. SOUDERS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLYN A. KRAUS

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 10/26/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13815 PROFESSIONAL CENTER DR STE 100
HUNTERSVILLE NC
28078-7951
US

IV. Provider business mailing address

2500 NESHAMINY INTERPLEX DR
TREVOSE PA
19053-6943
US

V. Phone/Fax

Practice location:
  • Phone: 704-384-1320
  • Fax: 704-316-3138
Mailing address:
  • Phone: 267-991-7666
  • Fax: 267-991-7615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW017257
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: