Basic Information
| Provider Information | |||||||||
| NPI: | 1730228149 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARDWELL | ||||||||
| FirstName: | CAROLONE | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 181 BURDETTE DR | ||||||||
| Address2: | |||||||||
| City: | MARTINSBURG | ||||||||
| State: | WV | ||||||||
| PostalCode: | 254017314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042621685 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 235 S WATER ST | ||||||||
| Address2: | |||||||||
| City: | MARTINSBURG | ||||||||
| State: | WV | ||||||||
| PostalCode: | 254014241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042638954 | ||||||||
| FaxNumber: | 3042640763 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | BP00942782 | WV | Y | Behavioral Health & Social Service Providers | Counselor |
ID Information
| ID | Type | State | Issuer | Description | BP00942782 | 01 | WV | LICENSE | OTHER |