Provider Demographics
NPI:1336907377
Name:MAULDIN, CALLIE (ALC)
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:
Last Name:MAULDIN
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1324
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35056-1324
Mailing Address - Country:US
Mailing Address - Phone:888-355-7080
Mailing Address - Fax:256-615-8632
Practice Address - Street 1:3440 MARTIN ST S STE 8
Practice Address - Street 2:
Practice Address - City:CROPWELL
Practice Address - State:AL
Practice Address - Zip Code:35054-3850
Practice Address - Country:US
Practice Address - Phone:888-355-7080
Practice Address - Fax:256-615-8632
Is Sole Proprietor?:No
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC04756101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional