Provider Demographics
NPI:1871266791
Name:CAMILLE RUDNEY LLC
Entity Type:Organization
Organization Name:CAMILLE RUDNEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUDNEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:804-373-7957
Mailing Address - Street 1:530 E MAIN ST STE 910
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23219-2428
Mailing Address - Country:US
Mailing Address - Phone:804-373-7957
Mailing Address - Fax:804-999-0451
Practice Address - Street 1:530 E MAIN ST STE 910
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-2428
Practice Address - Country:US
Practice Address - Phone:804-373-7957
Practice Address - Fax:804-999-0451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health