Provider Demographics
NPI:1265780043
Name:CAMP, SARAH KAITLIN (LCSW)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:KAITLIN
Last Name:CAMP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:KAITLIN
Other - Last Name:HOLBROOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CASE MANAGER
Mailing Address - Street 1:709 DAVIDSON ST
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-3607
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:482 INTERSTATE DR STE D
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-3409
Practice Address - Country:US
Practice Address - Phone:931-444-1000
Practice Address - Fax:931-728-1229
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
TN11042104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator