1285412346 NPI number — EDITH CAMILLE CAVER MS, LPC, ICAADC

Table of content: EDITH CAMILLE CAVER MS, LPC, ICAADC (NPI 1285412346)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285412346 NPI number — EDITH CAMILLE CAVER MS, LPC, ICAADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAVER
Provider First Name:
EDITH
Provider Middle Name:
CAMILLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, LPC, ICAADC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285412346
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2368 COUNTY ROAD 40 W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BILLINGSLEY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36006-3800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-430-5641
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4171 LOMAC STREET
Provider Second Line Business Practice Location Address:
SUITE F#1127
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-267-7599
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/20/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LPC05023 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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