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General NPI Number Information
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NPI Number | 1417142308
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Entity Type | Individual
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Provider Name | KIM CAUDELL
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Gender | Female
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Dates
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Enumeration Date | 09/13/2007
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Last Update Date | 09/13/2007
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Provider Practice Location Address
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Address Line | 1021 QUARRIER ST STE 515
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City | CHARLESTON
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State | WV
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Zip | 25301-2332
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Country | US
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Telephone | 304-346-9586
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Fax | 304-344-2169
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Provider Business Mailing Address
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Address Line | PO BOX 11210
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City | CHARLESTON
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State | WV
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Zip | 25339-1210
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Country | US
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Telephone | 304-346-9596
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Fax | 304-344-2169
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 953
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License Number State | WV
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