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General NPI Number Information
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NPI Number | 1750792628
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Entity Type | Individual
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Provider Name | CARA C CAMP MA
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Gender | Female
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Dates
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Enumeration Date | 05/14/2014
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Last Update Date | 12/16/2020
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Provider Practice Location Address
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Address Line | 3535 PARK ST STE 101B
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City | NORTON SHORES
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State | MI
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Zip | 49444-3736
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Country | US
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Telephone | 616-773-8985
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Fax |
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Provider Business Mailing Address
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Address Line | 9985 48TH AVE
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City | ALLENDALE
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State | MI
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Zip | 49401-8442
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Country | US
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Telephone | 616-773-8985
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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 | 6401017819
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License Number State | MI
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