1407110083 NPI number — MS. CAROLYN WEATHERLY CAMACHO LPC

Table of content: MS. CAROLYN WEATHERLY CAMACHO LPC (NPI 1407110083)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407110083 NPI number — MS. CAROLYN WEATHERLY CAMACHO LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMACHO
Provider First Name:
CAROLYN
Provider Middle Name:
WEATHERLY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHLEICHER
Provider Other First Name:
CAROLYN
Provider Other Middle Name:
WEATHERLY
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1407110083
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
835 E 65TH ST
Provider Second Line Business Mailing Address:
STE 106
Provider Business Mailing Address City Name:
SAVANNAH
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31405-4421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-692-0425
Provider Business Mailing Address Fax Number:
912-352-4361

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
835 E 65TH ST
Provider Second Line Business Practice Location Address:
STE 106
Provider Business Practice Location Address City Name:
SAVANNAH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31405-4421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-692-0425
Provider Business Practice Location Address Fax Number:
912-352-4361
Provider Enumeration Date:
06/28/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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