Healthcare Provider Details

I. General information

NPI: 1376210054
Provider Name (Legal Business Name): CAMILLA BAUCOM PIPPIN LCSW-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2719 GRAVES DR STE 5
GOLDSBORO NC
27534-4536
US

IV. Provider business mailing address

6845 US HIGHWAY 258 N
FARMVILLE NC
27828-9388
US

V. Phone/Fax

Practice location:
  • Phone: 919-330-4367
  • Fax: 919-330-4375
Mailing address:
  • Phone: 919-723-0577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP013841
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: