Provider Demographics
NPI:1972350320
Name:KOPPELMANN, CALEIGH (MS)
Entity type:Individual
Prefix:
First Name:CALEIGH
Middle Name:
Last Name:KOPPELMANN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8948 BRYSON BEND DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-3601
Mailing Address - Country:US
Mailing Address - Phone:704-401-9493
Mailing Address - Fax:
Practice Address - Street 1:616 NORTH BROOME ST
Practice Address - Street 2:101
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173
Practice Address - Country:US
Practice Address - Phone:980-202-2288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10214A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health