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General NPI Number Information
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NPI Number | 1942263223
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Entity Type | Organization
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Legal Business Name | CATHOLIC CHRITIES COUNSELING
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Dates
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Enumeration Date | 04/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1662 INGRAM RD CATHOLIC CHARITIES COUNSELING
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City | CHARLESTON
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State | SC
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Zip | 29407
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Country | US
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Telephone | 843-402-9115
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Fax | 843-402-9071
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Provider Business Mailing Address
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Address Line | 1662 INGRAM RD
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City | CHARLESTON
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State | SC
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Zip | 29407
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Country | US
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Telephone | 843-403-9115
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Fax | 843-402-9071
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. MARA CALDERON
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Credential | PHD PSYCHOLOGIST
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Telephone | 843-402-9115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 450
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License Number State | SC
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