Provider Demographics
NPI:1508903733
Name:CAMERON, KIMBERLY RAE (LCSW, CADC II)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:RAE
Last Name:CAMERON
Suffix:
Gender:F
Credentials:LCSW, CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 BELLEVUE AVE
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-3006
Mailing Address - Country:US
Mailing Address - Phone:503-913-4338
Mailing Address - Fax:
Practice Address - Street 1:24499 SW GRAHAMS FERRY RD
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-7523
Practice Address - Country:US
Practice Address - Phone:503-570-6563
Practice Address - Fax:503-570-6554
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR03-11-63101YA0400X
ORL38691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical