Provider Demographics
NPI:1629822853
Name:COMEAUX, CADIE (EDS)
Entity Type:Individual
Prefix:
First Name:CADIE
Middle Name:
Last Name:COMEAUX
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 BELLE HALL PKWY UNIT 202
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-8322
Mailing Address - Country:US
Mailing Address - Phone:843-412-0927
Mailing Address - Fax:843-225-2323
Practice Address - Street 1:501 BELLE HALL PKWY UNIT 202
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-8322
Practice Address - Country:US
Practice Address - Phone:843-412-0927
Practice Address - Fax:843-225-2323
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC239649103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool