Provider Demographics
NPI:1225263718
Name:HARRIS, CAMILLE (LPC)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2378 WHITES RDG
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-1110
Mailing Address - Country:US
Mailing Address - Phone:678-234-5078
Mailing Address - Fax:
Practice Address - Street 1:125 TOWNPARK DR NW STE 300
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-5812
Practice Address - Country:US
Practice Address - Phone:404-553-1291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005124101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional