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NPI Code Detail

MEDICARE: MONA ALICIA CAMUS SUDPT

MEDICARE: MONA ALICIA CAMUS SUDPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor61548191WA

General Provider Information

NPI Number : 1861225013
Entity Type Code : Individual
Provider Name (Legal Business Name) : MONA ALICIA CAMUS SUDPT
Provider Business Mailing Address
First Line : 1302 COMMERCE AVE
Second Line :
City : LONGVIEW
State : WA
Zip : 98632-3096
Country : US
Telephone Number : 360-423-2806
Fax Number :
Provider Business Practice Location Address
First Line : 1302 COMMERCE AVE
Second Line :
City : LONGVIEW
State : WA
Zip : 98632-3096
Country : US
Telephone Number : 360-423-2806
Fax Number : 360-423-5128
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2024
Last Update Date : 08/22/2024

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Directions to “ MONA ALICIA CAMUS SUDPT” Practice Location

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