Provider Demographics
NPI:1114572591
Name:MCCAMMON, CAMBRIA LEE
Entity Type:Individual
Prefix:
First Name:CAMBRIA
Middle Name:LEE
Last Name:MCCAMMON
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 1:7954 MISSION CENTER CT UNIT A
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1416
Mailing Address - Country:US
Mailing Address - Phone:530-277-6378
Mailing Address - Fax:
Practice Address - Street 1:7954 MISSION CENTER CT UNIT A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1416
Practice Address - Country:US
Practice Address - Phone:530-277-6378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-02
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health