Provider Demographics
NPI:1104231836
Name:CAUDILL, GABRHEA (SUDP, LMHC)
Entity type:Individual
Prefix:
First Name:GABRHEA
Middle Name:
Last Name:CAUDILL
Suffix:
Gender:F
Credentials:SUDP, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3051 W SIMS WAY
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-2255
Mailing Address - Country:US
Mailing Address - Phone:360-385-1258
Mailing Address - Fax:
Practice Address - Street 1:3051 W SIMS WAY
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-2255
Practice Address - Country:US
Practice Address - Phone:360-385-1258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-20
Last Update Date:2024-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MC61372103101YM0800X
WA60513121101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health