Provider Demographics
NPI:1952838203
Name:IRVIN, CAMRINESHA
Entity Type:Individual
Prefix:
First Name:CAMRINESHA
Middle Name:
Last Name:IRVIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2460 COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-2445
Mailing Address - Country:US
Mailing Address - Phone:225-239-5293
Mailing Address - Fax:
Practice Address - Street 1:2460 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-2445
Practice Address - Country:US
Practice Address - Phone:225-239-5293
Practice Address - Fax:225-244-7028
Is Sole Proprietor?:No
Enumeration Date:2017-05-17
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA600925226Medicaid