MEDICARE: GINA MARIE CALDARERA LAC

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	5078	LA

General Provider Information

NPI Number	:	1063239796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA MARIE CALDARERA LAC

Provider Business Mailing Address
First Line	:	3704 COBBLESTONE DR
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-2571
Country	:	US
Telephone Number	:	337-802-2927
Fax Number	:

Provider Business Practice Location Address
First Line	:	21089 S FRONTAGE RD
Second Line	:
City	:	LACASSINE
State	:	LA
Zip	:	70650
Country	:	US
Telephone Number	:	337-391-5052
Fax Number	:

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

Provider Enumeration Date	:	09/24/2024
Last Update Date	:	11/06/2024

Similar Medicare Providers

1528507068 — GENESIS LIFE LLC
Practice Location Address:

21089 SOUTH FRONTAGE ROAD
LACASSINE, LA
70650

Practice Phone: 337-936-9197
Practice Fax: 337-588-4179

1336688878 — SANCTUARY LOUISIANA, LLC
Practice Location Address:

21089 SOUTH FRONTAGE ROAD
LACASSINE, LA
70650

Practice Phone: 337-936-9197
Practice Fax: 337-588-4179

1588194336 — JAMES FITZGERALD MILLS CIT
Practice Location Address:

21089 SOUTH FRONTAGE RD
LACASSINE, LA
70650

Practice Phone: 337-936-9197
Practice Fax: 337-855-1829

1902377211 — SABRINA KAY WELLS
Practice Location Address:

21089 SOUTH FRONTAGE ROAD
LACASSINE, LA
70650

Practice Phone: 337-588-4166
Practice Fax:

1841853306 — MR. KELVIN MARTIN SMITH CIT
Practice Location Address:

21089 SOUTH FRONTAGE ROAD
LACASSINE, LA
70650

Practice Phone: 337-936-9197
Practice Fax: 337-588-4179

1982215851 — SANCTUARY LOUISIANA LLC
Practice Location Address:

21089 SOUTH FRONTAGE ROAD
LACASSINE, LA
70650-9998

Practice Phone: 337-936-9197
Practice Fax: 337-588-4179

Directions to “ GINA MARIE CALDARERA LAC” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.