Provider Demographics
NPI:1215275201
Name:CRADDOCK, CAROLYN G (MSW)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:G
Last Name:CRADDOCK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 SEMMES DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-7146
Mailing Address - Country:US
Mailing Address - Phone:910-452-9543
Mailing Address - Fax:
Practice Address - Street 1:334 SEMMES DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-7146
Practice Address - Country:US
Practice Address - Phone:910-452-9543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0028561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical