Provider Demographics
NPI:1104175918
Name:CALDWELL, LETISHA LEVATTE
Entity type:Individual
Prefix:
First Name:LETISHA
Middle Name:LEVATTE
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 E HERNDON AVE
Mailing Address - Street 2:#241
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3153
Mailing Address - Country:US
Mailing Address - Phone:559-974-2899
Mailing Address - Fax:
Practice Address - Street 1:611 E BELMONT AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701-1502
Practice Address - Country:US
Practice Address - Phone:559-237-3420
Practice Address - Fax:559-485-7244
Is Sole Proprietor?:No
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)