Individual
KIM CAUDELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1021 QUARRIER ST STE 515, CHARLESTON, WV 25301-2332
(304) 346-9586
(304) 344-2169
Mailing address
PO BOX 11210, CHARLESTON, WV 25339-1210
(304) 346-9596
(304) 344-2169
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
953
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810009722
—
WV
Enumeration date
09/13/2007
Last updated
09/13/2007
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