Provider Demographics
NPI:1699668988
Name:FLETCHER, CALVIN RANDOLPH JR
Entity type:Individual
Prefix:
First Name:CALVIN
Middle Name:RANDOLPH
Last Name:FLETCHER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 NEWCROFT AVE
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-3264
Mailing Address - Country:US
Mailing Address - Phone:202-813-5424
Mailing Address - Fax:
Practice Address - Street 1:908 NEWCROFT AVE
Practice Address - Street 2:
Practice Address - City:CAPITOL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-3264
Practice Address - Country:US
Practice Address - Phone:202-813-5424
Practice Address - Fax:202-813-5424
Is Sole Proprietor?:No
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG2000029171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical