Provider Demographics
NPI:1700939691
Name:CALDERON, CLAUDIA (LPC)
Entity Type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:
Last Name:CALDERON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 OAKVIEW RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-4338
Mailing Address - Country:US
Mailing Address - Phone:404-913-2434
Mailing Address - Fax:
Practice Address - Street 1:724 OAKVIEW RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-4338
Practice Address - Country:US
Practice Address - Phone:404-913-2434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLPC 1922101YP2500X
GALPC008938101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100098080AMedicaid
KS100098080COtherSED WAIVER
KS3620000Medicare ID - Type Unspecified