Healthcare Provider Details

I. General information

NPI: 1457770281
Provider Name (Legal Business Name): STEPHANIE A CAMP LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2014
Last Update Date: 11/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5820 YORK RD SUITE 202
BALTIMORE MD
21212-3610
US

IV. Provider business mailing address

4033 DEEPWOOD RD
BALTIMORE MD
21218-1404
US

V. Phone/Fax

Practice location:
  • Phone: 301-345-1022
  • Fax: 301-296-6100
Mailing address:
  • Phone: 410-652-1461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC6865
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: