Provider Demographics
NPI:1336739150
Name:CALDWELL, JAMES LOUIS JR
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:LOUIS
Last Name:CALDWELL
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3776 SULLIVAN ST STE E
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-2344
Mailing Address - Country:US
Mailing Address - Phone:256-334-9572
Mailing Address - Fax:
Practice Address - Street 1:3776 SULLIVAN ST STE E
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-2344
Practice Address - Country:US
Practice Address - Phone:256-334-9572
Practice Address - Fax:256-434-5165
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC3653A101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional