MEDICARE: A PLACE CALDWELL

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	251S00000X	Community/Behavioral Health Agency
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1275007650
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A PLACE CALDWELL

Provider Business Mailing Address
First Line	:	12410 STOWE ACRES DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-1001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9711 DAVID TAYLOR DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-2366
Country	:	US
Telephone Number	:	980-202-9064
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SAIONA CALDWELL
Credential	:	MSW, LCSW
Telephone Number	:	980-202-9064

Provider Enumeration Date	:	01/18/2019
Last Update Date	:	04/15/2020

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Directions to “A PLACE CALDWELL ” Practice Location

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