Provider Demographics
NPI:1013238542
Name:BOURCIER, CAMILLE ROSE (LCSW)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:ROSE
Last Name:BOURCIER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 SKYWAY
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-3280
Mailing Address - Country:US
Mailing Address - Phone:530-877-1965
Mailing Address - Fax:530-872-4896
Practice Address - Street 1:224 KAMEHAMEHA AVE # 201
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2860
Practice Address - Country:US
Practice Address - Phone:808-825-4214
Practice Address - Fax:866-985-6799
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-18
Last Update Date:2022-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW-4674104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker