Provider Demographics
NPI:1265820062
Name:CAMILLE, CLAIRMENCE
Entity Type:Individual
Prefix:
First Name:CLAIRMENCE
Middle Name:
Last Name:CAMILLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5824 LACONIA RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-6034
Mailing Address - Country:US
Mailing Address - Phone:407-504-5679
Mailing Address - Fax:
Practice Address - Street 1:5824 LACONIA RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-6034
Practice Address - Country:US
Practice Address - Phone:407-504-5679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-31
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health