Provider Demographics
NPI:1184432072
Name:PRINCE, CAULIN W
Entity type:Individual
Prefix:MR
First Name:CAULIN
Middle Name:W
Last Name:PRINCE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 RIVERHOUSE PL
Mailing Address - Street 2:1207
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70802-0000
Mailing Address - Country:US
Mailing Address - Phone:512-964-8468
Mailing Address - Fax:
Practice Address - Street 1:7564 EXCHANGE PLACE
Practice Address - Street 2:SUITE 201
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806
Practice Address - Country:US
Practice Address - Phone:225-819-7309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA104100000X171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator