Provider Demographics
NPI:1447751698
Name:THOMA, CAMILLE (LPC)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:
Last Name:THOMA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 CELEBRATION BLVD UNIT A
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-5585
Mailing Address - Country:US
Mailing Address - Phone:843-536-1180
Mailing Address - Fax:843-536-1116
Practice Address - Street 1:1340 CELEBRATION BLVD UNIT A
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-5585
Practice Address - Country:US
Practice Address - Phone:843-536-1180
Practice Address - Fax:843-536-1116
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6338101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional