Provider Demographics
NPI:1295049385
Name:PRICE, CAMILLA J (LPC)
Entity type:Individual
Prefix:
First Name:CAMILLA
Middle Name:J
Last Name:PRICE
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:PO BOX 1297
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28151-1297
Mailing Address - Country:US
Mailing Address - Phone:704-482-2460
Mailing Address - Fax:704-487-5950
Practice Address - Street 1:824 S DEKALB ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-6182
Practice Address - Country:US
Practice Address - Phone:704-482-2460
Practice Address - Fax:704-487-5950
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3461101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional