Provider Demographics
NPI:1033231816
Name:CAMPBELL-MASON, CLARICE CAMILLE (MS, MFTI)
Entity Type:Individual
Prefix:MS
First Name:CLARICE
Middle Name:CAMILLE
Last Name:CAMPBELL-MASON
Suffix:
Gender:F
Credentials:MS, MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11670 PROSPECT HILL DR
Mailing Address - Street 2:
Mailing Address - City:GOLD RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95670-8208
Mailing Address - Country:US
Mailing Address - Phone:916-635-9773
Mailing Address - Fax:
Practice Address - Street 1:14 N COTTONWOOD ST
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-2585
Practice Address - Country:US
Practice Address - Phone:530-666-8630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF48247101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health