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General NPI Number Information
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NPI Number | 1245886852
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Entity Type | Individual
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Provider Name | CAMILLE ELIZABETH BONDURANT MS, LPC-S
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Gender | Female
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Dates
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Enumeration Date | 08/11/2019
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Last Update Date | 08/11/2019
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Provider Practice Location Address
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Address Line | 140 MAYFAIR RD STE 2100
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City | HATTIESBURG
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State | MS
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Zip | 39402-1702
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Country | US
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Telephone | 601-310-8307
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Fax |
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Provider Business Mailing Address
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Address Line | 101 MONARCH BLVD
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City | HATTIESBURG
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State | MS
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Zip | 39402-7203
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Country | US
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Telephone | 601-310-8307
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Fax |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0744
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License Number State | MS
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