Provider Demographics
NPI:1679014476
Name:MCCORMICK, CAMILLE MERCEDES (LPC)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:MERCEDES
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 N 15TH ST # 150
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4327
Mailing Address - Country:US
Mailing Address - Phone:480-447-0581
Mailing Address - Fax:602-926-1414
Practice Address - Street 1:7600 N 15TH ST # 150
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-4327
Practice Address - Country:US
Practice Address - Phone:480-447-0581
Practice Address - Fax:602-926-1414
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-16529101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional