Provider Demographics
NPI:1437495645
Name:MCCOY, CAMILLA WILSON
Entity Type:Individual
Prefix:
First Name:CAMILLA
Middle Name:WILSON
Last Name:MCCOY
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 1:105 VICAR PL
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-1241
Mailing Address - Country:US
Mailing Address - Phone:434-272-8372
Mailing Address - Fax:434-381-4316
Practice Address - Street 1:105 VICAR PL
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-1241
Practice Address - Country:US
Practice Address - Phone:434-272-8372
Practice Address - Fax:434-381-4316
Is Sole Proprietor?:No
Enumeration Date:2012-12-14
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
VA0701005374101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional