Provider Demographics
NPI:1770339632
Name:JONES, CAMILLE TATUM (DSW, LMSW)
Entity type:Individual
Prefix:DR
First Name:CAMILLE
Middle Name:TATUM
Last Name:JONES
Suffix:
Gender:F
Credentials:DSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3617 LARGO RD STE C
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-7853
Mailing Address - Country:US
Mailing Address - Phone:240-334-7162
Mailing Address - Fax:
Practice Address - Street 1:3617 LARGO RD STE C
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-7853
Practice Address - Country:US
Practice Address - Phone:240-334-7162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11473101YM0800X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health