Provider Demographics
NPI:1063239796
Name:CALDARERA, GINA MARIE (LAC)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:CALDARERA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3704 COBBLESTONE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-2571
Mailing Address - Country:US
Mailing Address - Phone:337-802-2927
Mailing Address - Fax:
Practice Address - Street 1:21089 S FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:LACASSINE
Practice Address - State:LA
Practice Address - Zip Code:70650
Practice Address - Country:US
Practice Address - Phone:337-391-5052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-24
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5078101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)