Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 0701009289 | VA |
NPI | 1003438862 |
---|---|
Provider Name | Caitlin Cavanaugh |
First Address | Virginia Beach, VA 23451-1234 |
Second Address | Virginia Beach, VA 23452-7523 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2020 |
Last Update Date | 14/05/2020 |