Healthcare Provider Details

I. General information

NPI: 1578326302
Provider Name (Legal Business Name): CALDWELL COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 02/05/2024
Certification Date: 02/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2198 INGLESIDE AVE
MACON GA
31204-2030
US

IV. Provider business mailing address

2198 INGLESIDE AVE
MACON GA
31204-2030
US

V. Phone/Fax

Practice location:
  • Phone: 478-292-2591
  • Fax:
Mailing address:
  • Phone: 478-292-2591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. COURTNEY B CALDWELL
Title or Position: OWNER
Credential: DSW LCSW
Phone: 478-550-3171