Provider Demographics
NPI:1164912614
Name:CALDWELL, JENNY LYNNE (MA, LMFTA)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:LYNNE
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:MA, LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3440 TORINGDON WAY STE 205
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-3191
Mailing Address - Country:US
Mailing Address - Phone:704-995-0342
Mailing Address - Fax:
Practice Address - Street 1:3440 TORINGDON WAY STE 205
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3191
Practice Address - Country:US
Practice Address - Phone:704-995-0342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12096A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty