Provider Demographics
NPI:1619193182
Name:CALDWELL, MENDEL EUSTACE JR (MED, LPC)
Entity Type:Individual
Prefix:
First Name:MENDEL
Middle Name:EUSTACE
Last Name:CALDWELL
Suffix:JR
Gender:M
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1836 ASHLEY RIVER RD
Mailing Address - Street 2:BOX 224
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-4781
Mailing Address - Country:US
Mailing Address - Phone:843-813-7165
Mailing Address - Fax:843-763-7202
Practice Address - Street 1:1293 ORANGE GROVE RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-3947
Practice Address - Country:US
Practice Address - Phone:843-813-7165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3471101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional