Provider Demographics
NPI:1073382685
Name:CAUDLE, WENDY A
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:A
Last Name:CAUDLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32075 NC HWY 24 27
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-9484
Mailing Address - Country:US
Mailing Address - Phone:704-244-1011
Mailing Address - Fax:704-985-1341
Practice Address - Street 1:124 E NORTH ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-4048
Practice Address - Country:US
Practice Address - Phone:704-985-1088
Practice Address - Fax:704-985-1341
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-22
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist