Provider Demographics
NPI:1033651708
Name:COLON, CALEB
Entity Type:Individual
Prefix:MR
First Name:CALEB
Middle Name:
Last Name:COLON
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 1:12075 MAGAZINE ST
Mailing Address - Street 2:APT. 12206
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-5526
Mailing Address - Country:US
Mailing Address - Phone:413-204-2726
Mailing Address - Fax:
Practice Address - Street 1:12075 MAGAZINE ST
Practice Address - Street 2:APT. 12206
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-5526
Practice Address - Country:US
Practice Address - Phone:413-204-2726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-13
Last Update Date:2016-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health