Provider Demographics
NPI:1902439516
Name:FORD, CAITLIN
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19056 GREENBUSH RD
Mailing Address - Street 2:
Mailing Address - City:PARKSLEY
Mailing Address - State:VA
Mailing Address - Zip Code:23421
Mailing Address - Country:US
Mailing Address - Phone:757-665-1260
Mailing Address - Fax:
Practice Address - Street 1:19056 GREENBUSH RD
Practice Address - Street 2:
Practice Address - City:PARKSLEY
Practice Address - State:VA
Practice Address - Zip Code:23421
Practice Address - Country:US
Practice Address - Phone:757-665-1260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040114611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical