Healthcare Provider Details

I. General information

NPI: 1871264911
Provider Name (Legal Business Name): CAMILLE WARD LCSW, LCAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2021
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2670 DURHAM CHAPEL HILL BLVD
DURHAM NC
27707-2829
US

IV. Provider business mailing address

501 SORRELL ST
CARY NC
27513-4027
US

V. Phone/Fax

Practice location:
  • Phone: 919-251-9001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-27250
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC016353
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: