Provider Demographics
NPI:1740878495
Name:DURHAM, CALVIN (M/A, LCAS-A)
Entity type:Individual
Prefix:
First Name:CALVIN
Middle Name:
Last Name:DURHAM
Suffix:
Gender:M
Credentials:M/A, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3215 ARKLOW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-0998
Mailing Address - Country:US
Mailing Address - Phone:980-214-0719
Mailing Address - Fax:
Practice Address - Street 1:3215 ARKLOW RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-0998
Practice Address - Country:US
Practice Address - Phone:980-214-0719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25998101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor