Provider Demographics
NPI:1902386030
Name:GAINES, CAMILLA TAMIKA (LMSW)
Entity Type:Individual
Prefix:MS
First Name:CAMILLA
Middle Name:TAMIKA
Last Name:GAINES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CCB 4FL 1720 2ND AVENUE SOUTH
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35294-2050
Mailing Address - Country:US
Mailing Address - Phone:205-996-5049
Mailing Address - Fax:205-975-8950
Practice Address - Street 1:UAB COMMUNITY PSYCHIATRY 908 20TH STREET SOUTH RM 487
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35294-0001
Practice Address - Country:US
Practice Address - Phone:205-996-5049
Practice Address - Fax:205-975-8950
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3581G1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical