Provider Demographics
NPI:1407534811
Name:CALDWELL, DEANDRE (LLMSW)
Entity Type:Individual
Prefix:
First Name:DEANDRE
Middle Name:
Last Name:CALDWELL
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 743
Mailing Address - Street 2:
Mailing Address - City:INKSTER
Mailing Address - State:MI
Mailing Address - Zip Code:48141-0743
Mailing Address - Country:US
Mailing Address - Phone:734-224-3889
Mailing Address - Fax:
Practice Address - Street 1:39111 6 MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3926
Practice Address - Country:US
Practice Address - Phone:734-224-3889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker