Provider Demographics
NPI:1376210054
Name:PIPPIN, CAMILLA BAUCOM (LCSW-A)
Entity Type:Individual
Prefix:
First Name:CAMILLA
Middle Name:BAUCOM
Last Name:PIPPIN
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6845 US HIGHWAY 258 N
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27828-9388
Mailing Address - Country:US
Mailing Address - Phone:919-723-0577
Mailing Address - Fax:
Practice Address - Street 1:2719 GRAVES DR STE 5
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-4536
Practice Address - Country:US
Practice Address - Phone:919-330-4367
Practice Address - Fax:919-330-4375
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0138411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical