Provider Demographics
NPI:1497319503
Name:CAUDILL, MASHAWNA (MSW)
Entity Type:Individual
Prefix:
First Name:MASHAWNA
Middle Name:
Last Name:CAUDILL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 LOVERN ST
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-1773
Mailing Address - Country:US
Mailing Address - Phone:606-910-4414
Mailing Address - Fax:606-910-4382
Practice Address - Street 1:113 LOVERN ST
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-1773
Practice Address - Country:US
Practice Address - Phone:606-910-4414
Practice Address - Fax:606-910-4382
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY253822101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health