Healthcare Provider Details

I. General information

NPI: 1952476095
Provider Name (Legal Business Name): KRISTINE L CAUDILL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 E MARKET ST
YORK PA
17401-1221
US

IV. Provider business mailing address

821 LATIMER ST
YORK PA
17404-2531
US

V. Phone/Fax

Practice location:
  • Phone: 717-845-6624
  • Fax: 717-845-6626
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC004349
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: