MEDICARE: CHRISTINE CALVERT LCDC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	11340	TX

General Provider Information

NPI Number	:	1033525936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE CALVERT LCDC

Provider Business Mailing Address
First Line	:	3818 SPICEWOOD SPRINGS RD
Second Line	:	SUITE 400
City	:	AUSTIN
State	:	TX
Zip	:	78759-8968
Country	:	US
Telephone Number	:	830-377-5334
Fax Number	:

Provider Business Practice Location Address
First Line	:	15919 BOOTH CIR
Second Line	:
City	:	VOLENTE
State	:	TX
Zip	:	78641-9679
Country	:	US
Telephone Number	:	830-377-5334
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2014
Last Update Date	:	07/11/2014

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Directions to “ CHRISTINE CALVERT LCDC” Practice Location

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