Provider Demographics
NPI:1972945996
Name:CALDWELL-COLLINS, KERRYANN
Entity type:Individual
Prefix:
First Name:KERRYANN
Middle Name:
Last Name:CALDWELL-COLLINS
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 1:8009 MAINSAIL DR
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-8186
Mailing Address - Country:US
Mailing Address - Phone:707-477-6114
Mailing Address - Fax:
Practice Address - Street 1:101 WIKIUP DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1375
Practice Address - Country:US
Practice Address - Phone:707-495-3410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105587106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist