Provider Demographics
NPI:1164189817
Name:CUDMORE, CASEY C (RBT)
Entity Type:Individual
Prefix:MS
First Name:CASEY
Middle Name:C
Last Name:CUDMORE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 SUMMERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30021-3401
Mailing Address - Country:US
Mailing Address - Phone:404-432-7984
Mailing Address - Fax:
Practice Address - Street 1:2105 SUMMERWOOD DR
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:GA
Practice Address - Zip Code:30021-3401
Practice Address - Country:US
Practice Address - Phone:404-432-7984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician