Provider Demographics
NPI:1073211819
Name:ROBARTS, CAMILLA LYNN (MA, LPC)
Entity Type:Individual
Prefix:
First Name:CAMILLA
Middle Name:LYNN
Last Name:ROBARTS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4506 HWY 17 BUS UNIT B
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-5635
Mailing Address - Country:US
Mailing Address - Phone:843-212-6862
Mailing Address - Fax:
Practice Address - Street 1:4506 HWY 17 BUS UNIT B
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-5635
Practice Address - Country:US
Practice Address - Phone:843-212-6862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-21
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010161101YP2500X
SC8518101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional