Healthcare Provider Details

I. General information

NPI: 1437495645
Provider Name (Legal Business Name): CAMILLA WILSON MCCOY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAMILLA MARKETA MCCOY

II. Dates (important events)

Enumeration Date: 12/14/2012
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 PINEY FOREST ROAD
DANVILLE VA
24540
US

IV. Provider business mailing address

500 PINEY FOREST ROAD
DANVILLE VA
24540
US

V. Phone/Fax

Practice location:
  • Phone: 434-272-8372
  • Fax: 434-381-4316
Mailing address:
  • Phone: 434-272-8372
  • Fax: 434-381-4316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701005374
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401224612
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLH61566999
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12692
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: