Provider Demographics
NPI:1356952691
Name:CALDWELL, NICOLE M (LCSW)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 SIERRA TRL
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28390-7230
Mailing Address - Country:US
Mailing Address - Phone:910-261-3966
Mailing Address - Fax:
Practice Address - Street 1:918 SIERRA TRL
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:NC
Practice Address - Zip Code:28390-7230
Practice Address - Country:US
Practice Address - Phone:910-261-3966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0173151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical