Provider Demographics
NPI:1912017153
Name:CALDERON, GEORGE (CDP)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:CALDERON
Suffix:
Gender:M
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 SPRUCE ST
Mailing Address - Street 2:STE. 300
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2474
Mailing Address - Country:US
Mailing Address - Phone:206-461-6935
Mailing Address - Fax:206-461-8382
Practice Address - Street 1:1629 N 45TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6701
Practice Address - Country:US
Practice Address - Phone:206-633-3350
Practice Address - Fax:206-633-3113
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00017014101Y00000X
WACP00002230101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)