Provider Demographics
NPI:1619600996
Name:MCCOY, CAMERON ROBEN (LLMSW)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:ROBEN
Last Name:MCCOY
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30602 OAKRIDGE MANOR DR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-7738
Mailing Address - Country:US
Mailing Address - Phone:586-585-6061
Mailing Address - Fax:
Practice Address - Street 1:2750 CARPENTER RD STE 5
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1170
Practice Address - Country:US
Practice Address - Phone:586-585-6061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511034001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical