Provider Demographics
NPI:1952142895
Name:CAMP ACADEMIA, INC.
Entity type:Organization
Organization Name:CAMP ACADEMIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER AND CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PENNEBAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:706-884-4492
Mailing Address - Street 1:907 NEW FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-1203
Mailing Address - Country:US
Mailing Address - Phone:706-884-4492
Mailing Address - Fax:
Practice Address - Street 1:907 NEW FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-1203
Practice Address - Country:US
Practice Address - Phone:706-884-4492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty