Healthcare Provider Details

I. General information

NPI: 1942742838
Provider Name (Legal Business Name): CATHERINE CAUDILL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2016
Last Update Date: 08/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6208 FITZHUGH AVE
RICHMOND VA
23226-2813
US

IV. Provider business mailing address

6208 FITZHUGH AVE
RICHMOND VA
23226-2813
US

V. Phone/Fax

Practice location:
  • Phone: 276-608-1152
  • Fax:
Mailing address:
  • Phone: 276-608-1152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number37903
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904010644
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: