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General NPI Number Information
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NPI Number | 1588924062
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Entity Type | Individual
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Provider Name | CAROL A. CALVERT LPC
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Gender | Female
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Dates
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Enumeration Date | 05/18/2012
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Last Update Date | 05/18/2012
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Provider Practice Location Address
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Address Line | 601 W PONCE DE LEON AVE
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City | DECATUR
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State | GA
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Zip | 30030-2952
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Country | US
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Telephone | 404-457-3393
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 465
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City | AVONDALE ESTATES
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State | GA
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Zip | 30002-0465
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Country | US
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Telephone | 404-457-3393
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Fax |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC002092
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License Number State | GA
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