Healthcare Provider Details

I. General information

NPI: 1245291376
Provider Name (Legal Business Name): ELAINE H. CAUDILL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 ROANOKE BLVD
SALEM VA
24153-6404
US

IV. Provider business mailing address

1970 ROANOKE BLVD
SALEM VA
24153-6404
US

V. Phone/Fax

Practice location:
  • Phone: 540-982-2463
  • Fax: 540-855-5052
Mailing address:
  • Phone: 540-982-2463
  • Fax: 540-855-5052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904003470
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: