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General NPI Number Information
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NPI Number | 1265596118
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Entity Type | Individual
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Provider Name | THRESA ANNETTE CALDWELL M.A., LBSW
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Gender | Female
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Dates
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Enumeration Date | 12/21/2006
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 1705 COUNTY ROAD 256
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City | NACOGDOCHES
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State | TX
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Zip | 75965-0415
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Country | US
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Telephone | 936-560-4365
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Fax | 936-560-4365
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Provider Business Mailing Address
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Address Line | 1705 COUNTY ROAD 256
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City | NACOGDOCHES
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State | TX
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Zip | 75965-0415
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Country | US
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Telephone | 936-560-4365
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Fax | 936-560-4365
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 27886
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License Number State | TX
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