Healthcare Provider Details

I. General information

NPI: 1295049385
Provider Name (Legal Business Name): CAMILLA J PRICE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2010
Last Update Date: 07/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 S DEKALB ST
SHELBY NC
28150-6182
US

IV. Provider business mailing address

PO BOX 1297
SHELBY NC
28151-1297
US

V. Phone/Fax

Practice location:
  • Phone: 704-482-2460
  • Fax: 704-487-5950
Mailing address:
  • Phone: 704-482-2460
  • Fax: 704-487-5950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3461
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: