Provider Demographics
NPI:1255972246
Name:ROCHA-WALLACE, CAMILLE CELESTE
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:CELESTE
Last Name:ROCHA-WALLACE
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 1:2769 VALENCIA RD
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-9616
Mailing Address - Country:US
Mailing Address - Phone:831-889-8100
Mailing Address - Fax:
Practice Address - Street 1:2769 VALENCIA RD
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-9616
Practice Address - Country:US
Practice Address - Phone:831-889-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-01
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program