Provider Demographics
NPI:1124008925
Name:CALVERT, CASEY P (LPC)
Entity Type:Individual
Prefix:MS
First Name:CASEY
Middle Name:P
Last Name:CALVERT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11285 ELKINS RD
Mailing Address - Street 2:D-3
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-1259
Mailing Address - Country:US
Mailing Address - Phone:678-622-1178
Mailing Address - Fax:
Practice Address - Street 1:11285 ELKINS RD
Practice Address - Street 2:D-3
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1259
Practice Address - Country:US
Practice Address - Phone:678-622-1178
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4143101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional