Provider Demographics
NPI:1700086725
Name:CAMELOT CARE CENTERS
Entity Type:Organization
Organization Name:CAMELOT CARE CENTERS
Other - Org Name:CAMELOT CARE CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:VEALE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:615-370-4227
Mailing Address - Street 1:2991 FORT HENRY DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-4005
Mailing Address - Country:US
Mailing Address - Phone:423-392-2975
Mailing Address - Fax:423-392-2983
Practice Address - Street 1:2991 FORT HENRY DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-4005
Practice Address - Country:US
Practice Address - Phone:423-392-2975
Practice Address - Fax:423-392-2983
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROVIDENCE SERVICE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-18
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health