Healthcare Provider Details

I. General information

NPI: 1164191896
Provider Name (Legal Business Name): CAMILLE MARIA VACA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAMILLE MARIA MCLARNEY LCSW

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1032 FORBISHIRE DR
MATTHEWS NC
28104-6828
US

IV. Provider business mailing address

1032 FORBISHIRE DR
MATTHEWS NC
28104-6828
US

V. Phone/Fax

Practice location:
  • Phone: 704-651-9663
  • Fax:
Mailing address:
  • Phone: 704-651-9663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC002274
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: