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General NPI Number Information
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NPI Number | 1033428875
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Entity Type | Organization
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Legal Business Name | CAMDEN C & A
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Dates
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Enumeration Date | 09/28/2010
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Last Update Date | 09/28/2010
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Provider Practice Location Address
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Address Line | 100 MARINERS DR SUITE D
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City | KINGSLAND
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State | GA
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Zip | 31548-6666
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Country | US
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Telephone | 912-449-7111
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Fax | 912-449-7060
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Provider Business Mailing Address
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Address Line | 1007 MARY ST
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City | WAYCROSS
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State | GA
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Zip | 31503-3823
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Country | US
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Telephone | 912-449-7111
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Fax | 912-449-7060
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Authorized Official
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Title or Position | DEO
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Name | GLYN THOMAS
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Credential | PHD
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Telephone | 912-449-7103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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