Provider Demographics
NPI:1720158041
Name:CALDWELL, SAMMY RAY (MSW)
Entity Type:Individual
Prefix:
First Name:SAMMY
Middle Name:RAY
Last Name:CALDWELL
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 DEERWOOD ST
Mailing Address - Street 2:UNIT C-6
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-4142
Mailing Address - Country:US
Mailing Address - Phone:803-782-8917
Mailing Address - Fax:
Practice Address - Street 1:511 W MOULTRIE ST
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:SC
Practice Address - Zip Code:29180-1436
Practice Address - Country:US
Practice Address - Phone:803-712-1649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2710101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health