Provider Demographics
NPI:1669755658
Name:CALVIN, LA KEISHA
Entity type:Individual
Prefix:
First Name:LA KEISHA
Middle Name:
Last Name:CALVIN
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 1:1205 S TRYON ST
Mailing Address - Street 2:#1440
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-4288
Mailing Address - Country:US
Mailing Address - Phone:704-920-8711
Mailing Address - Fax:
Practice Address - Street 1:1205 S TRYON ST
Practice Address - Street 2:#1440
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4288
Practice Address - Country:US
Practice Address - Phone:704-920-8711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health