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General NPI Number Information
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NPI Number | 1497164925
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Entity Type | Individual
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Provider Name | CAMILLE GOETHE SMITH MSW
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Gender | Female
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Dates
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Enumeration Date | 08/08/2014
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 4102 W HIGHWAY 390
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City | LYNN HAVEN
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State | FL
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Zip | 32444-4580
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Country | US
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Telephone | 850-624-0584
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Fax | 850-248-2469
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Provider Business Mailing Address
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Address Line | 4035 OSPREY PT
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City | PANAMA CITY
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State | FL
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Zip | 32409-2129
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Country | US
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Telephone | 850-445-1031
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Fax | 850-248-2469
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW23807
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License Number State | FL
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