Provider Demographics
NPI:1326293796
Name:BOONE, CAMILLE DIONE (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:DIONE
Last Name:BOONE
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 SAWTOOTH DR APT 4
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-4509
Mailing Address - Country:US
Mailing Address - Phone:336-736-1189
Mailing Address - Fax:
Practice Address - Street 1:341 SAWTOOTH DR APT 4
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-4509
Practice Address - Country:US
Practice Address - Phone:336-736-1189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-26
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NC1600106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health