Provider Demographics
NPI:1295183432
Name:CADDY, KIRBY DANIELLE
Entity Type:Individual
Prefix:MISS
First Name:KIRBY
Middle Name:DANIELLE
Last Name:CADDY
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 1:1100 N UNIVERSITY AVE
Mailing Address - Street 2:EVERGREEN PLACE SUITE 200
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-6343
Mailing Address - Country:US
Mailing Address - Phone:501-516-5725
Mailing Address - Fax:
Practice Address - Street 1:1100 N UNIVERSITY AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-6343
Practice Address - Country:US
Practice Address - Phone:501-686-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-27
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical