Provider Demographics
NPI:1750792628
Name:CAMP, CARA C (MA)
Entity type:Individual
Prefix:
First Name:CARA
Middle Name:C
Last Name:CAMP
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:C
Other - Last Name:ROP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:9985 48TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49401-8442
Mailing Address - Country:US
Mailing Address - Phone:616-773-8985
Mailing Address - Fax:
Practice Address - Street 1:3535 PARK ST STE 101B
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49444-3736
Practice Address - Country:US
Practice Address - Phone:616-773-8985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-14
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401017819101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1464983Medicaid
MI6401017819OtherPROFESSIONAL COUNSELOR