Provider Demographics
NPI:1982994497
Name:COLPITTS, CAMILLE ELISA
Entity Type:Individual
Prefix:MISS
First Name:CAMILLE
Middle Name:ELISA
Last Name:COLPITTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 W AVENUE J STE C
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-3443
Mailing Address - Country:US
Mailing Address - Phone:661-949-0131
Mailing Address - Fax:
Practice Address - Street 1:2919 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3917
Practice Address - Country:US
Practice Address - Phone:415-229-0500
Practice Address - Fax:415-647-3662
Is Sole Proprietor?:No
Enumeration Date:2011-04-18
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA94-1747575101YA0400X
101YM0800X
CA94460101YM0800X, 106H00000X
CAIMF94460101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CVILLACREZOtherCCR