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General NPI Number Information
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NPI Number | 1912017153
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Entity Type | Individual
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Provider Name | GEORGE CALDERON CDP
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Gender | Male
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 09/29/2015
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Provider Practice Location Address
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Address Line | 1629 N 45TH ST
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City | SEATTLE
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State | WA
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Zip | 98103-6701
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Country | US
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Telephone | 206-633-3350
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Fax | 206-633-3113
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Provider Business Mailing Address
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Address Line | 905 SPRUCE ST STE. 300
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City | SEATTLE
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State | WA
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Zip | 98104-2474
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Country | US
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Telephone | 206-461-6935
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Fax | 206-461-8382
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | RC00017014
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CP00002230
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License Number State | WA
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