Provider Demographics
NPI:1992458319
Name:ANDERSEN, CAITLYN (NCC, LCMHC-A)
Entity type:Individual
Prefix:MS
First Name:CAITLYN
Middle Name:
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:NCC, LCMHC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2154 BRITTON RD APT 101
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-1337
Mailing Address - Country:US
Mailing Address - Phone:803-412-4983
Mailing Address - Fax:
Practice Address - Street 1:1608 QUEEN ST STE 3
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-5527
Practice Address - Country:US
Practice Address - Phone:919-790-8580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17220101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health