Healthcare Provider Details

I. General information

NPI: 1225699432
Provider Name (Legal Business Name): CAITLIN ALEXANDRA HARDING LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CAITLIN ALEXANDRA HARDING LPC

II. Dates (important events)

Enumeration Date: 06/27/2019
Last Update Date: 11/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 S CHURCH ST
SMITHFIELD VA
23430-1858
US

IV. Provider business mailing address

1000 COMMERCIAL LN
SUFFOLK VA
23434-8148
US

V. Phone/Fax

Practice location:
  • Phone: 757-357-7458
  • Fax: 757-356-1808
Mailing address:
  • Phone: 757-262-7091
  • Fax: 757-356-1808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: