Healthcare Provider Details

I. General information

NPI: 1801225735
Provider Name (Legal Business Name): CAMILLE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2013
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 WOODLANE RD MEDFORD MEADOWS GROUP HOME
MOUNT HOLLY NJ
08060
US

IV. Provider business mailing address

212 E MADISON AVE
MAGNOLIA NJ
08049-1409
US

V. Phone/Fax

Practice location:
  • Phone: 609-267-5928
  • Fax:
Mailing address:
  • Phone: 856-361-2720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC00649300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: