Provider Demographics
NPI:1467233288
Name:CALLENDER, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:CALLENDER
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 1:236 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23224-3933
Mailing Address - Country:US
Mailing Address - Phone:540-236-2460
Mailing Address - Fax:
Practice Address - Street 1:1900 CHATSWORTH AVE
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-2946
Practice Address - Country:US
Practice Address - Phone:804-323-2831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2023-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040148491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0904014839OtherVIRGINIA BOARD OF SOCIAL WORK