Provider Demographics
NPI:1235706508
Name:THAYER, CAMILLE (LCPC-C)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:
Last Name:THAYER
Suffix:
Gender:F
Credentials:LCPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CAROLINE WAY
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-2184
Mailing Address - Country:US
Mailing Address - Phone:207-213-0679
Mailing Address - Fax:
Practice Address - Street 1:125 PRESUMPSCOT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-5225
Practice Address - Country:US
Practice Address - Phone:207-871-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL6247101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health