Provider Demographics
NPI:1710255641
Name:CAIN, CARLA DENINE (BS, CADC)
Entity Type:Individual
Prefix:MS
First Name:CARLA
Middle Name:DENINE
Last Name:CAIN
Suffix:
Gender:F
Credentials:BS, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801-4440
Mailing Address - Country:US
Mailing Address - Phone:302-397-8860
Mailing Address - Fax:
Practice Address - Street 1:604 W 10TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-1424
Practice Address - Country:US
Practice Address - Phone:302-737-4100
Practice Address - Fax:302-656-1294
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1083101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)