Provider Demographics
NPI:1245886852
Name:BONDURANT, CAMILLE ELIZABETH (MS, LPC-S)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:ELIZABETH
Last Name:BONDURANT
Suffix:
Gender:F
Credentials:MS, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MONARCH BLVD
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-7203
Mailing Address - Country:US
Mailing Address - Phone:601-310-8307
Mailing Address - Fax:
Practice Address - Street 1:140 MAYFAIR RD STE 2100
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1702
Practice Address - Country:US
Practice Address - Phone:601-310-8307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-11
Last Update Date:2019-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0744101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional