Provider Demographics
NPI:1154825859
Name:HOLLAND, CAMILLE MARION (MS)
Entity Type:Individual
Prefix:MS
First Name:CAMILLE
Middle Name:MARION
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76500 DELENA MAYGER RD
Mailing Address - Street 2:
Mailing Address - City:RAINIER
Mailing Address - State:OR
Mailing Address - Zip Code:97048-2015
Mailing Address - Country:US
Mailing Address - Phone:503-468-9464
Mailing Address - Fax:541-588-8418
Practice Address - Street 1:76500 DELENA MAYGER RD
Practice Address - Street 2:
Practice Address - City:RAINIER
Practice Address - State:OR
Practice Address - Zip Code:97048-2015
Practice Address - Country:US
Practice Address - Phone:503-468-9464
Practice Address - Fax:541-588-8418
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-19
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61171350101Y00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health