Provider Demographics
NPI:1457157596
Name:CAMERON, TERESA (MS)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:CAMERON
Suffix:
Gender:
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 TORRINGTON RD
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-2624
Mailing Address - Country:US
Mailing Address - Phone:803-351-2030
Mailing Address - Fax:
Practice Address - Street 1:801 GERVAIS ST STE 2B
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-3125
Practice Address - Country:US
Practice Address - Phone:803-888-6714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10242101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional