Provider Demographics
NPI:1952673576
Name:CAUDELL, GINGER L (ALC, MS)
Entity Type:Individual
Prefix:MRS
First Name:GINGER
Middle Name:L
Last Name:CAUDELL
Suffix:
Gender:F
Credentials:ALC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1162
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36265-5162
Mailing Address - Country:US
Mailing Address - Phone:256-239-5662
Mailing Address - Fax:256-217-4162
Practice Address - Street 1:613 PELHAM RD S
Practice Address - Street 2:SUITE 2
Practice Address - City:JACKSONVILLE
Practice Address - State:AL
Practice Address - Zip Code:36265-2772
Practice Address - Country:US
Practice Address - Phone:256-239-5662
Practice Address - Fax:256-217-4162
Is Sole Proprietor?:No
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC1716A101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional