Provider Demographics
NPI:1619755857
Name:CALDWELL, DORTHEA (LMHC)
Entity Type:Individual
Prefix:
First Name:DORTHEA
Middle Name:
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SHERWOOD FOREST PL
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-6097
Mailing Address - Country:US
Mailing Address - Phone:334-552-0427
Mailing Address - Fax:
Practice Address - Street 1:458 MANAWAI ST APT 805
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-4604
Practice Address - Country:US
Practice Address - Phone:808-973-5178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMHC-977101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health