Provider Demographics
NPI:1851533061
Name:CAUDLE, SOPHIA D (LPC)
Entity Type:Individual
Prefix:MRS
First Name:SOPHIA
Middle Name:D
Last Name:CAUDLE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:SOPHIA
Other - Middle Name:D
Other - Last Name:CLAYPOOLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:406 N BUCHANAN BLVD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-1728
Mailing Address - Country:US
Mailing Address - Phone:919-698-7061
Mailing Address - Fax:
Practice Address - Street 1:406 N BUCHANAN BLVD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-1728
Practice Address - Country:US
Practice Address - Phone:919-698-7061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3539101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health