Provider Demographics
NPI:1245967843
Name:CALDWELL, SHAQUAYLA CHEVONNE (CDCA)
Entity type:Individual
Prefix:MRS
First Name:SHAQUAYLA
Middle Name:CHEVONNE
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 BRYDEN RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-1759
Mailing Address - Country:US
Mailing Address - Phone:614-808-3198
Mailing Address - Fax:
Practice Address - Street 1:813 BRYDEN RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-1759
Practice Address - Country:US
Practice Address - Phone:614-808-3198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.181261101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)