Provider Demographics
NPI:1730642588
Name:ROWE, CAMILLE JEWEL (BA MPA)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:JEWEL
Last Name:ROWE
Suffix:
Gender:F
Credentials:BA MPA
Other - Prefix:
Other - First Name:CAMILLE
Other - Middle Name:JEWEL
Other - Last Name:TALLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BA MPA
Mailing Address - Street 1:9339 BASSWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-6194
Mailing Address - Country:US
Mailing Address - Phone:917-710-8270
Mailing Address - Fax:
Practice Address - Street 1:9339 BASSWOOD WAY
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-6194
Practice Address - Country:US
Practice Address - Phone:917-710-8270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-09
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty