Provider Demographics
NPI:1629185145
Name:PRATHER, CALVIN WHEELER (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CALVIN
Middle Name:WHEELER
Last Name:PRATHER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 CAMINO DEL RIO SOUTH
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4022
Mailing Address - Country:US
Mailing Address - Phone:619-282-4600
Mailing Address - Fax:619-624-0178
Practice Address - Street 1:3511 CAMINO DEL RIO SOUTH
Practice Address - Street 2:SUITE 500
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4022
Practice Address - Country:US
Practice Address - Phone:619-282-4600
Practice Address - Fax:619-624-0178
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS105191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SW10519Medicare ID - Type Unspecified