Provider Demographics
NPI:1750901831
Name:CALDERWOOD, SCOTT D (MA, LPC/A)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:D
Last Name:CALDERWOOD
Suffix:
Gender:M
Credentials:MA, LPC/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2058 SILVERCREST DR UNIT B
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-4237
Mailing Address - Country:US
Mailing Address - Phone:843-503-9064
Mailing Address - Fax:
Practice Address - Street 1:2058 SILVERCREST DR UNIT B
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-4237
Practice Address - Country:US
Practice Address - Phone:843-503-9064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-20
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7091101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health