Provider Demographics
NPI:1396993275
Name:CHILDERS, CAROL RUTH (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:RUTH
Last Name:CHILDERS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1262
Mailing Address - Street 2:
Mailing Address - City:SUNRISE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65079-1262
Mailing Address - Country:US
Mailing Address - Phone:909-224-2069
Mailing Address - Fax:
Practice Address - Street 1:252 JUPITER RD
Practice Address - Street 2:
Practice Address - City:CAMDENTON
Practice Address - State:MO
Practice Address - Zip Code:65020-4442
Practice Address - Country:US
Practice Address - Phone:909-224-2069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS131331041C0700X
MO20040292961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical