Provider Demographics
NPI:1093828535
Name:VAN CAMP, MARY KATHERINE (LMSW, ACSW)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KATHERINE
Last Name:VAN CAMP
Suffix:
Gender:F
Credentials:LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:787 MARKET ST.
Mailing Address - Street 2:SUITES 9 &10
Mailing Address - City:HANCOCK
Mailing Address - State:MI
Mailing Address - Zip Code:49930
Mailing Address - Country:US
Mailing Address - Phone:906-482-7762
Mailing Address - Fax:906-482-7893
Practice Address - Street 1:787 MARKET ST.
Practice Address - Street 2:SUITES 9 & 10
Practice Address - City:HANCOCK
Practice Address - State:MI
Practice Address - Zip Code:49930
Practice Address - Country:US
Practice Address - Phone:906-482-7762
Practice Address - Fax:906-482-7893
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010706021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical