Provider Demographics
NPI:1184394215
Name:CALVIN, DEANDRA MILAM
Entity type:Individual
Prefix:MRS
First Name:DEANDRA
Middle Name:MILAM
Last Name:CALVIN
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 1:6332 SANDBOURNE W
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-6562
Mailing Address - Country:US
Mailing Address - Phone:901-230-4305
Mailing Address - Fax:
Practice Address - Street 1:1321 MURFREESBORO PIKE STE 511
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37217-2626
Practice Address - Country:US
Practice Address - Phone:615-938-0527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6996101Y00000X, 101YM0800X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health