Provider Demographics
NPI:1811487002
Name:TEIXEIRA, CAMILLE (LCSW)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:
Last Name:TEIXEIRA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 TRACE COLONY PARK DR STE B
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-8810
Mailing Address - Country:US
Mailing Address - Phone:800-801-2050
Mailing Address - Fax:
Practice Address - Street 1:2200 8TH ST
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-4006
Practice Address - Country:US
Practice Address - Phone:504-349-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-14
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA131261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical