| Doctor Name: | DR. JACK E CAMILLERI |
| NPI Number: | 1073689493 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | ED.D.,LPC & LMFT |
| License Number: | AL626 |
| Business Practice Address: | 28311 N Main St Suite 100 Daphne, AL - 365267074 |
| Business Phone Number: | 2516251480 |
| Business Fax Number: | 2516251482 |
| Mailing Address: | Po Box 3116, DAPHNE |
| State: | AL |
| Postal Code: | 365263116 |
| Phone Number: | 2516251480 |
| Fax Number: | 2516251482 |
| NPI Enumeration Date: | 11/28/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | AL626 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | AL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |