MEDICARE: ELIZABETH CALDWELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	21289	NC
2	101YP2500X	Professional Counselor	QS135516	NC
3	1041C0700X	Clinical Social Worker	C010223	NC

General Provider Information

NPI Number	:	1801202429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH CALDWELL

Provider Business Mailing Address
First Line	:	2539 MCARTHUR LANDING CIR APT 102
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28311-9019
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2931 BREEZEWOOD AVE STE 200
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28303-5281
Country	:	US
Telephone Number	:	910-489-9036
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2014
Last Update Date	:	08/18/2025

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Directions to “ ELIZABETH CALDWELL ” Practice Location

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