Provider Demographics
NPI:1407635345
Name:CAMERON, MARIA EVA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:EVA
Last Name:CAMERON
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 1:5855 JIMMY CARTER BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-2984
Mailing Address - Country:US
Mailing Address - Phone:404-630-1361
Mailing Address - Fax:
Practice Address - Street 1:5855 JIMMY CARTER BLVD STE 200
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-2984
Practice Address - Country:US
Practice Address - Phone:404-630-1361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA013106101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health