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General NPI Number Information
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NPI Number | 1215940515
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Entity Type | Individual
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Provider Name | CHARISSA C CAMP PH.D., ABPP
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Gender | Female
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 07/23/2007
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Provider Practice Location Address
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Address Line | 6263 POPLAR AVE SUITE 932
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City | MEMPHIS
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State | TN
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Zip | 38119-4738
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Country | US
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Telephone | 901-761-1511
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Fax |
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Provider Business Mailing Address
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Address Line | 6263 POPLAR AVE SUITE 932
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City | MEMPHIS
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State | TN
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Zip | 38119-4738
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Country | US
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Telephone | 901-761-1511
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Fax | 901-761-1116
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | P2077
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License Number State | TN
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