Provider Demographics
NPI:1225444854
Name:CALDWELL, JARRED (PHD)
Entity Type:Individual
Prefix:DR
First Name:JARRED
Middle Name:
Last Name:CALDWELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 DANIEL ELLIS DR
Mailing Address - Street 2:8307
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-3034
Mailing Address - Country:US
Mailing Address - Phone:843-501-1444
Mailing Address - Fax:
Practice Address - Street 1:520 FOLLY RD
Practice Address - Street 2:#219
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-3019
Practice Address - Country:US
Practice Address - Phone:843-501-1444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1422103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist