Provider Demographics
NPI:1033525936
Name:CALVERT, CHRISTINE (LCDC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:CALVERT
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3818 SPICEWOOD SPRINGS RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8968
Mailing Address - Country:US
Mailing Address - Phone:830-377-5334
Mailing Address - Fax:
Practice Address - Street 1:15919 BOOTH CIR
Practice Address - Street 2:
Practice Address - City:VOLENTE
Practice Address - State:TX
Practice Address - Zip Code:78641-9679
Practice Address - Country:US
Practice Address - Phone:830-377-5334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11340101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)