Provider Demographics
NPI:1013459619
Name:CALDWELL, STELLA
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 PARKWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488-2554
Mailing Address - Country:US
Mailing Address - Phone:843-909-0458
Mailing Address - Fax:
Practice Address - Street 1:4401 BELLE OAKS DR
Practice Address - Street 2:SUITE 280
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-8537
Practice Address - Country:US
Practice Address - Phone:843-571-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7324104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker