| Doctor Name: | IHORI KAMEYAMA |
| NPI Number: | 1063694404 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC |
| License Number: | LPC004585 |
| Business Practice Address: | 150 Memorial Dr. Reidsville, GA - 30453 |
| Business Phone Number: | 9125576794 |
| Business Fax Number: | 9125576817 |
| Mailing Address: | Po Box 745, STATESBORO |
| State: | GA |
| Postal Code: | 304590745 |
| Phone Number: | 9127646906 |
| Fax Number: | 9127643252 |
| NPI Enumeration Date: | 11/28/2007 |
| NPI Last Update Date: | 11/28/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | LPC004585 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |