Provider Demographics
NPI:1174031058
Name:MCCAMMON, OLIVIA (LAC, MT-BC)
Entity Type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:
Last Name:MCCAMMON
Suffix:
Gender:F
Credentials:LAC, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 N WARWICK RD APT 34B
Mailing Address - Street 2:
Mailing Address - City:SOMERDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:08083-1960
Mailing Address - Country:US
Mailing Address - Phone:215-565-5083
Mailing Address - Fax:
Practice Address - Street 1:925 ROUTE 73N
Practice Address - Street 2:SUITE H
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053
Practice Address - Country:US
Practice Address - Phone:856-380-1399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-13
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist