Healthcare Provider Details

I. General information

NPI: 1447269998
Provider Name (Legal Business Name): CASEY MICHELLE CAULK BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 MALLARD ST GREENVILLE MENTAL HEALTH
GREENVILLE SC
29601-4046
US

IV. Provider business mailing address

124 MALLARD ST GREENVILLE MENTAL HEALTH CENTER
GREENVILLE SC
29601-4046
US

V. Phone/Fax

Practice location:
  • Phone: 864-241-1040
  • Fax: 864-241-1016
Mailing address:
  • Phone: 864-241-1040
  • Fax: 864-241-1016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: