Provider Demographics
NPI:1225699432
Name:HARDING, CAITLIN ALEXANDRA (LPC)
Entity Type:Individual
Prefix:MISS
First Name:CAITLIN
Middle Name:ALEXANDRA
Last Name:HARDING
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:CAITLIN
Other - Middle Name:ALEXANDRA
Other - Last Name:HARDING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:1000 COMMERCIAL LN
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-8148
Mailing Address - Country:US
Mailing Address - Phone:757-262-7091
Mailing Address - Fax:757-356-1808
Practice Address - Street 1:1801 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:VA
Practice Address - Zip Code:23430-1858
Practice Address - Country:US
Practice Address - Phone:757-357-7458
Practice Address - Fax:757-356-1808
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1689615296Medicaid