Provider Demographics
NPI:1811451941
Name:MOORE, CAMILLA JOY (LPC,NCC)
Entity type:Individual
Prefix:MRS
First Name:CAMILLA
Middle Name:JOY
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPC,NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:989 GREYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-2251
Mailing Address - Country:US
Mailing Address - Phone:228-438-0377
Mailing Address - Fax:
Practice Address - Street 1:4262 POPPS FERRY RD
Practice Address - Street 2:
Practice Address - City:DIBERVILLE
Practice Address - State:MS
Practice Address - Zip Code:39540-2391
Practice Address - Country:US
Practice Address - Phone:601-384-7551
Practice Address - Fax:601-384-7551
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2191101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional