Provider Demographics
NPI:1427002674
Name:CAUTHEN, SHERRI D (LCSW)
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:D
Last Name:CAUTHEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 E LAKE DR APT 12
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-4906
Mailing Address - Country:US
Mailing Address - Phone:770-743-7405
Mailing Address - Fax:
Practice Address - Street 1:1924 CLAIRMONT RD STE 105
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-3438
Practice Address - Country:US
Practice Address - Phone:770-743-7405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2019-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0047931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME098304OtherANTHEM LEGACY NUMBER
ME403720099Medicaid
ME403720099Medicaid