Provider Demographics
NPI:1013051580
Name:BROOM, CAMILLE HUTCHINS (LPC)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:HUTCHINS
Last Name:BROOM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2170 E FORK RD
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37743-7820
Mailing Address - Country:US
Mailing Address - Phone:423-480-9121
Mailing Address - Fax:
Practice Address - Street 1:2170 E FORK RD
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743-7820
Practice Address - Country:US
Practice Address - Phone:423-480-9121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4781101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor