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General NPI Number Information
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NPI Number | 1023365756
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Entity Type | Individual
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Provider Name | CAROLYN A. SOUDERS LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/13/2012
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Last Update Date | 10/26/2020
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Provider Practice Location Address
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Address Line | 13815 PROFESSIONAL CENTER DR STE 100
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-7951
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Country | US
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Telephone | 704-384-1320
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Fax | 704-316-3138
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Provider Business Mailing Address
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Address Line | 2500 NESHAMINY INTERPLEX DR
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City | TREVOSE
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State | PA
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Zip | 19053-6943
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Country | US
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Telephone | 267-991-7666
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Fax | 267-991-7615
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW017257
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License Number State | PA
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