Provider Demographics
NPI:1902419724
Name:CARA C. CAMP, LLC
Entity Type:Organization
Organization Name:CARA C. CAMP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CARA
Authorized Official - Middle Name:C
Authorized Official - Last Name:CAMP
Authorized Official - Suffix:
Authorized Official - Credentials:MA LPC
Authorized Official - Phone:616-426-1784
Mailing Address - Street 1:9985 48TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49401-8442
Mailing Address - Country:US
Mailing Address - Phone:616-773-8985
Mailing Address - Fax:
Practice Address - Street 1:3535 PARK ST STE 101B
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49444-3736
Practice Address - Country:US
Practice Address - Phone:616-773-8985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-31
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6401017819OtherPROFESSIONAL COUNSELOR