Provider Demographics
NPI:1265295604
Name:WADUD, CAROLYN (FOUNDER)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:WADUD
Suffix:
Gender:F
Credentials:FOUNDER
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:
Other - Last Name:WADUD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3136 ALLEGHENY AVE APT A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43209-1268
Mailing Address - Country:US
Mailing Address - Phone:614-849-5585
Mailing Address - Fax:
Practice Address - Street 1:3136 ALLEGHENY AVE APT A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43209-1268
Practice Address - Country:US
Practice Address - Phone:614-849-5585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator