Provider Demographics
NPI:1164191896
Name:VACA, CAMILLE MARIA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CAMILLE
Middle Name:MARIA
Last Name:VACA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:CAMILLE
Other - Middle Name:MARIA
Other - Last Name:MCLARNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1032 FORBISHIRE DR
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28104-6828
Mailing Address - Country:US
Mailing Address - Phone:704-651-9663
Mailing Address - Fax:
Practice Address - Street 1:1032 FORBISHIRE DR
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28104-6828
Practice Address - Country:US
Practice Address - Phone:704-651-9663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
C0022741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical