Provider Demographics
NPI:1609036524
Name:MCCAMEY, JIMMY DAWSON JR (PHD, LCSW, LPC)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:DAWSON
Last Name:MCCAMEY
Suffix:JR
Gender:M
Credentials:PHD, LCSW, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 RIDLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-2231
Mailing Address - Country:US
Mailing Address - Phone:706-523-1114
Mailing Address - Fax:844-273-4209
Practice Address - Street 1:419 RIDLEY AVE
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-2231
Practice Address - Country:US
Practice Address - Phone:706-523-1114
Practice Address - Fax:844-273-4209
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003852101YP2500X, 1041C0700X
GACSW0031531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA514073675AMedicaid