Provider Demographics
NPI:1942263223
Name:CATHOLIC CHRITIES COUNSELING
Entity Type:Organization
Organization Name:CATHOLIC CHRITIES COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARA
Authorized Official - Middle Name:
Authorized Official - Last Name:CALDERON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD PSYCHOLOGIST
Authorized Official - Phone:843-402-9115
Mailing Address - Street 1:1662 INGRAM RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407
Mailing Address - Country:US
Mailing Address - Phone:843-403-9115
Mailing Address - Fax:843-402-9071
Practice Address - Street 1:1662 INGRAM RD
Practice Address - Street 2:CATHOLIC CHARITIES COUNSELING
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407
Practice Address - Country:US
Practice Address - Phone:843-402-9115
Practice Address - Fax:843-402-9071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC450103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty