Provider Demographics
NPI:1669846036
Name:CAMACHO, FAVIOLA (MS)
Entity Type:Individual
Prefix:
First Name:FAVIOLA
Middle Name:
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3104 W KENNEWICK AVE STE C
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-2993
Mailing Address - Country:US
Mailing Address - Phone:509-619-0519
Mailing Address - Fax:888-482-2725
Practice Address - Street 1:3104 W KENNEWICK AVE STE C
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2993
Practice Address - Country:US
Practice Address - Phone:509-619-0519
Practice Address - Fax:888-482-2725
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-21
Last Update Date:2015-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health