Doctor Name: | NICOLE L CAMMACK |
NPI Number: | 1699144113 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PH.D. |
License Number: | 05412 |
Business Practice Address: | 2480 Llewellyn Ave Fort George G Meade, MD - 207557081 |
Business Phone Number: | 2404123437 |
Business Fax Number: | 3016778957 |
Mailing Address: | 2480 Llewellyn Ave, FORT GEORGE G MEADE |
State: | MD |
Postal Code: | 207557081 |
Phone Number: | 2404123437 |
Fax Number: | 3016778957 |
NPI Enumeration Date: | 09/15/2015 |
NPI Last Update Date: | 09/15/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 05412 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |