Provider Demographics
NPI:1801960166
Name:CAUDILL, NANCY ANN (LCSW)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:ANN
Last Name:CAUDILL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4449 STRAIGHT LINE RD
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32539-6720
Mailing Address - Country:US
Mailing Address - Phone:850-683-3900
Mailing Address - Fax:850-683-3908
Practice Address - Street 1:4449 STRAIGHT LINE RD
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539-6720
Practice Address - Country:US
Practice Address - Phone:850-683-3900
Practice Address - Fax:850-683-3908
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW77611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL767117200Medicaid