Healthcare Provider Details

I. General information

NPI: 1275007650
Provider Name (Legal Business Name): A PLACE CALDWELL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2019
Last Update Date: 04/15/2020
Certification Date: 04/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9711 DAVID TAYLOR DR
CHARLOTTE NC
28262-2366
US

IV. Provider business mailing address

12410 STOWE ACRES DR
CHARLOTTE NC
28262-1001
US

V. Phone/Fax

Practice location:
  • Phone: 980-202-9064
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SAIONA CALDWELL
Title or Position: OWNER
Credential: MSW, LCSW
Phone: 980-202-9064