Provider Demographics
NPI:1376961250
Name:GARCIA, CAMILLE (MFTI)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:CAMILLE
Other - Middle Name:
Other - Last Name:WILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18327 SIERRA DR
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-4342
Mailing Address - Country:US
Mailing Address - Phone:707-326-0442
Mailing Address - Fax:
Practice Address - Street 1:429 SPEERS RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-3123
Practice Address - Country:US
Practice Address - Phone:707-571-2215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-28
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF79126106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist