Provider Demographics
NPI:1467875443
Name:TEETER, CAITLIN CUNNINGHAM (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:CUNNINGHAM
Last Name:TEETER
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 PARADISE CIR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-3545
Mailing Address - Country:US
Mailing Address - Phone:304-541-8252
Mailing Address - Fax:
Practice Address - Street 1:105 PARADISE CIR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-3545
Practice Address - Country:US
Practice Address - Phone:304-541-8252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-28
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP009433171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical