Provider Demographics
NPI:1518511740
Name:CALEB, MAUDESTA SCOTT (LPC)
Entity Type:Individual
Prefix:
First Name:MAUDESTA
Middle Name:SCOTT
Last Name:CALEB
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1247 PARAMOUNT CT
Mailing Address - Street 2:
Mailing Address - City:HEPHZIBAH
Mailing Address - State:GA
Mailing Address - Zip Code:30815-4554
Mailing Address - Country:US
Mailing Address - Phone:478-241-4349
Mailing Address - Fax:
Practice Address - Street 1:4039 GATEWAY BLVD STE 201
Practice Address - Street 2:
Practice Address - City:GROVETOWN
Practice Address - State:GA
Practice Address - Zip Code:30813-3390
Practice Address - Country:US
Practice Address - Phone:706-432-6866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-25
Last Update Date:2023-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010166101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional