Healthcare Provider Details

I. General information

NPI: 1427410398
Provider Name (Legal Business Name): BRENDA KAY CALDWELL LCAS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 MORGANTON BLVD SW
LENOIR NC
28645-9691
US

IV. Provider business mailing address

1819 PEACHTREE RD NE STE 450
ATLANTA GA
30309-1853
US

V. Phone/Fax

Practice location:
  • Phone: 828-394-5563
  • Fax:
Mailing address:
  • Phone: 404-968-2667
  • Fax: 770-783-5136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number22583
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA12432
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: