Provider Demographics
NPI:1710440441
Name:CAUDILL, BRITTA D (DSW, LCSW)
Entity Type:Individual
Prefix:DR
First Name:BRITTA
Middle Name:D
Last Name:CAUDILL
Suffix:
Gender:F
Credentials:DSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 FRASURE HILL DR
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-8910
Mailing Address - Country:US
Mailing Address - Phone:606-506-4291
Mailing Address - Fax:606-506-0147
Practice Address - Street 1:140 FRASURE HILL DR
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-8910
Practice Address - Country:US
Practice Address - Phone:606-506-4219
Practice Address - Fax:606-506-0147
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-10
Last Update Date:2024-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2539981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100589540Medicaid