Provider Demographics
NPI:1063980779
Name:CALDWELL, WILLIAM NEIL
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:NEIL
Last Name:CALDWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:WILLIAM
Other - Middle Name:NEIL
Other - Last Name:CALDWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCADC
Mailing Address - Street 1:241 N DEPOT ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:KY
Mailing Address - Zip Code:40033
Mailing Address - Country:US
Mailing Address - Phone:270-699-1542
Mailing Address - Fax:
Practice Address - Street 1:241 N DEPOT ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:KY
Practice Address - Zip Code:40033-1419
Practice Address - Country:US
Practice Address - Phone:270-699-1542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-12
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY172660101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)