Provider Demographics
NPI:1639498215
Name:RHOADES, CAMILLE S (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:CAMILLE
Middle Name:S
Last Name:RHOADES
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MS
Other - First Name:CAMILLE
Other - Middle Name:S
Other - Last Name:AZZAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9475 BRIAR VILLAGE PT STE 215
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920
Mailing Address - Country:US
Mailing Address - Phone:719-357-8957
Mailing Address - Fax:
Practice Address - Street 1:9475 BRIAR VILLAGE PT STE 215
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7908
Practice Address - Country:US
Practice Address - Phone:719-357-8957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-22
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0017175101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional