Provider Demographics
NPI:1134130529
Name:CAMERON, MARILYN MARGARET (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:MARGARET
Last Name:CAMERON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6024 W MAPLE RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4405
Mailing Address - Country:US
Mailing Address - Phone:248-489-1550
Mailing Address - Fax:248-489-9767
Practice Address - Street 1:6024 W MAPLE RD
Practice Address - Street 2:SUITE 107
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4405
Practice Address - Country:US
Practice Address - Phone:248-489-1550
Practice Address - Fax:248-489-9767
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401005997101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional