Provider Demographics
NPI:1417306630
Name:SUMMONS, CAMILLE ROSS (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CAMILLE
Middle Name:ROSS
Last Name:SUMMONS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 KINGS WAY
Mailing Address - Street 2:
Mailing Address - City:AVENAL
Mailing Address - State:CA
Mailing Address - Zip Code:93204-9708
Mailing Address - Country:US
Mailing Address - Phone:559-386-0587
Mailing Address - Fax:
Practice Address - Street 1:1 KINGS WAY
Practice Address - Street 2:
Practice Address - City:AVENAL
Practice Address - State:CA
Practice Address - Zip Code:93204-9708
Practice Address - Country:US
Practice Address - Phone:559-386-0587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS125081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical