MEDICARE: BEVERLY CADDELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	8539	SC

General Provider Information

NPI Number	:	1225895741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEVERLY CADDELL

Provider Business Mailing Address
First Line	:	7407 PURSER LN
Second Line	:
City	:	HANAHAN
State	:	SC
Zip	:	29410-8291
Country	:	US
Telephone Number	:	843-494-3801
Fax Number	:

Provider Business Practice Location Address
First Line	:	259 SEVEN FARMS DR
Second Line	:
City	:	DANIEL ISLAND
State	:	SC
Zip	:	29492-7553
Country	:	US
Telephone Number	:	843-606-0791
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2024
Last Update Date	:	03/01/2024

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Directions to “ BEVERLY CADDELL ” Practice Location

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