Provider Demographics
NPI:1164918496
Name:CAMP LOUD AND SERVICES
Entity Type:Organization
Organization Name:CAMP LOUD AND SERVICES
Other - Org Name:CAMP LOUD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MYRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH-JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-609-8914
Mailing Address - Street 1:3280 ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-3203
Mailing Address - Country:US
Mailing Address - Phone:757-271-4555
Mailing Address - Fax:
Practice Address - Street 1:3280 ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703-3203
Practice Address - Country:US
Practice Address - Phone:757-271-4555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-10
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health