Provider Demographics
NPI:1689300790
Name:CALDWELL-BRISCOE, TEJANAE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:TEJANAE
Middle Name:
Last Name:CALDWELL-BRISCOE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:738 PINE LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-4033
Mailing Address - Country:US
Mailing Address - Phone:770-238-2989
Mailing Address - Fax:
Practice Address - Street 1:738 PINE LN
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-4033
Practice Address - Country:US
Practice Address - Phone:770-238-2989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33010661A1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool