Provider Demographics
NPI:1548022858
Name:KUDER, CAROLYN ELAINE (RBT)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:ELAINE
Last Name:KUDER
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 BOONE HILL RD
Mailing Address - Street 2:APT W8
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-2475
Mailing Address - Country:US
Mailing Address - Phone:843-718-6895
Mailing Address - Fax:
Practice Address - Street 1:1711 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-9320
Practice Address - Country:US
Practice Address - Phone:843-718-6895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician