=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174031058
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | OLIVIA MCCAMMON LPC, MT-BC, NCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2018
-----------------------------------------------------
Last Update Date | 08/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 221 LAUREL RD STE 102
-----------------------------------------------------
City | VOORHEES
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08043-8301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-772-5809
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 413 N WARWICK RD APT 34B
-----------------------------------------------------
City | SOMERDALE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08083-1960
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-565-5083
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225A00000X
-----------------------------------------------------
Taxonomy Name | Music Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 37PC01167000
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------