Provider Demographics
NPI:1780988279
Name:CALDWELL, GLORIA (CRISIS COUNSELOR)
Entity type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:CRISIS COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2635 W DESCHUTES AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-3004
Mailing Address - Country:US
Mailing Address - Phone:509-783-0500
Mailing Address - Fax:
Practice Address - Street 1:2635 W DESCHUTES AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-3004
Practice Address - Country:US
Practice Address - Phone:509-783-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-27
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA251S00000X101YM101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health