Provider Demographics
NPI:1760073472
Name:CALDWELL, MARQUIA SHANTE (LPC)
Entity Type:Individual
Prefix:
First Name:MARQUIA
Middle Name:SHANTE
Last Name:CALDWELL
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 1:1747 CITADEL PLZ STE 205
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-1017
Mailing Address - Country:US
Mailing Address - Phone:210-467-5395
Mailing Address - Fax:
Practice Address - Street 1:1747 CITADEL PLZ STE 205
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1017
Practice Address - Country:US
Practice Address - Phone:210-467-5395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-27
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82239101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional