Provider Demographics
NPI:1982213047
Name:FIRELINE, CAMERYN (MED)
Entity Type:Individual
Prefix:MS
First Name:CAMERYN
Middle Name:
Last Name:FIRELINE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 HERTIAGE VILLAGE PLZ
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-3056
Mailing Address - Country:US
Mailing Address - Phone:571-284-5336
Mailing Address - Fax:703-743-5036
Practice Address - Street 1:7101 HERTIAGE VILLAGE PLZ
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3056
Practice Address - Country:US
Practice Address - Phone:571-284-5336
Practice Address - Fax:703-743-5036
Is Sole Proprietor?:No
Enumeration Date:2020-07-24
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst