Provider Demographics
NPI:1750093076
Name:CAMILLE Y HUMES, LLC
Entity type:Organization
Organization Name:CAMILLE Y HUMES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:HUMES
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:708-259-9819
Mailing Address - Street 1:995 N PONTIAC TRAIL
Mailing Address - Street 2:#151
Mailing Address - City:WALLED LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48390
Mailing Address - Country:US
Mailing Address - Phone:708-259-9819
Mailing Address - Fax:
Practice Address - Street 1:1841 BIRCHWOOD CIRCLE
Practice Address - Street 2:
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48390
Practice Address - Country:US
Practice Address - Phone:708-259-9819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty