Provider Demographics
NPI:1336472463
Name:CALDERON, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:CALDERON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-2713
Mailing Address - Country:US
Mailing Address - Phone:516-581-6312
Mailing Address - Fax:
Practice Address - Street 1:855 S BECKFORD DR
Practice Address - Street 2:SUITE C
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-5945
Practice Address - Country:US
Practice Address - Phone:252-438-5667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1512101YA0400X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)