Provider Demographics
NPI:1326691403
Name:FOLKERTS, CALEB WILLIAM-THOMAS (LPCC)
Entity Type:Individual
Prefix:
First Name:CALEB
Middle Name:WILLIAM-THOMAS
Last Name:FOLKERTS
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 FOUNTAIN SQUARE DR APT 18A5
Mailing Address - Street 2:
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-4670
Mailing Address - Country:US
Mailing Address - Phone:618-973-1889
Mailing Address - Fax:
Practice Address - Street 1:25 N CANFIELD NILES RD
Practice Address - Street 2:
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-2328
Practice Address - Country:US
Practice Address - Phone:330-449-0694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101YM0800X
OHE.1800941101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health