Provider Demographics
NPI:1457652034
Name:WALTERS, CAMILLE (MA)
Entity Type:Individual
Prefix:MS
First Name:CAMILLE
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:CAMILLE
Other - Middle Name:
Other - Last Name:DENTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1620 N MAIN ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-4653
Mailing Address - Country:US
Mailing Address - Phone:925-286-6050
Mailing Address - Fax:925-937-6782
Practice Address - Street 1:1620 N MAIN ST
Practice Address - Street 2:SUITE #1
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4653
Practice Address - Country:US
Practice Address - Phone:925-286-6050
Practice Address - Fax:925-937-6782
Is Sole Proprietor?:No
Enumeration Date:2010-11-12
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician