Provider Demographics
NPI:1437812617
Name:SELPH, CAITLYN COTA (MSW, LCSW, GC-C)
Entity Type:Individual
Prefix:MRS
First Name:CAITLYN
Middle Name:COTA
Last Name:SELPH
Suffix:
Gender:F
Credentials:MSW, LCSW, GC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:873 CHESHAM AVE
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-5985
Mailing Address - Country:US
Mailing Address - Phone:706-829-1495
Mailing Address - Fax:
Practice Address - Street 1:207 HUDSON TRCE STE 100
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-2010
Practice Address - Country:US
Practice Address - Phone:706-204-1366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-14
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0077281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical