Provider Demographics
NPI:1023365756
Name:SOUDERS, CAROLYN A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:A
Last Name:SOUDERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:A
Other - Last Name:KRAUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2500 NESHAMINY INTERPLEX DR
Mailing Address - Street 2:
Mailing Address - City:TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-6943
Mailing Address - Country:US
Mailing Address - Phone:267-991-7666
Mailing Address - Fax:267-991-7615
Practice Address - Street 1:13815 PROFESSIONAL CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7951
Practice Address - Country:US
Practice Address - Phone:704-384-1320
Practice Address - Fax:704-316-3138
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0172571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical