Provider Demographics
NPI:1750786083
Name:CAMERON, JOANNA (LPC)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:CAMERON
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 1:2538 OAK CREEK LN
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-6868
Mailing Address - Country:US
Mailing Address - Phone:404-451-8628
Mailing Address - Fax:
Practice Address - Street 1:1035 GREEN ST SE
Practice Address - Street 2:SUITE B
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-5466
Practice Address - Country:US
Practice Address - Phone:404-451-8628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007722101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional