Healthcare Provider Details

I. General information

NPI: 1033525936
Provider Name (Legal Business Name): CHRISTINE CALVERT LCDC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2014
Last Update Date: 07/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15919 BOOTH CIR
VOLENTE TX
78641-9679
US

IV. Provider business mailing address

3818 SPICEWOOD SPRINGS RD SUITE 400
AUSTIN TX
78759-8968
US

V. Phone/Fax

Practice location:
  • Phone: 830-377-5334
  • Fax:
Mailing address:
  • Phone: 830-377-5334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number11340
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: