Healthcare Provider Details

I. General information

NPI: 1275480949
Provider Name (Legal Business Name): BRANDON CAUDILL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2026
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 W MARKET ST
AKRON OH
44313-7000
US

IV. Provider business mailing address

1815 W MARKET ST
AKRON OH
44313-7000
US

V. Phone/Fax

Practice location:
  • Phone: 330-993-4649
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.193920
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: