Provider Demographics
NPI:1932989308
Name:CALDWELL, VICTORIA LYNNE
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:LYNNE
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 TOURNAMENT DR SW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-5553
Mailing Address - Country:US
Mailing Address - Phone:704-786-3652
Mailing Address - Fax:
Practice Address - Street 1:239 TOURNAMENT DR SW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-5553
Practice Address - Country:US
Practice Address - Phone:704-786-3652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician