Provider Demographics
NPI:1013548965
Name:CALDWELL, GEORGIA (BS , CADC)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:BS , CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6115 HICKORY GROVE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-4207
Mailing Address - Country:US
Mailing Address - Phone:704-532-4262
Mailing Address - Fax:
Practice Address - Street 1:6115 HICKORY GROVE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-4207
Practice Address - Country:US
Practice Address - Phone:704-532-4262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23125101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)