Provider Demographics
NPI:1063168763
Name:CAMDEN COUNTRY TREATMENT CENTER
Entity type:Organization
Organization Name:CAMDEN COUNTRY TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LIC PROF COUSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:LORI
Authorized Official - Last Name:DENNING
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:215-341-4140
Mailing Address - Street 1:1418 N. VODGES ST.
Mailing Address - Street 2:
Mailing Address - City:PHILAPELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131
Mailing Address - Country:US
Mailing Address - Phone:215-341-4140
Mailing Address - Fax:
Practice Address - Street 1:6650 BROWNING ROAD U-11E
Practice Address - Street 2:
Practice Address - City:PENNSAUKEN
Practice Address - State:NJ
Practice Address - Zip Code:08109
Practice Address - Country:US
Practice Address - Phone:856-406-6120
Practice Address - Fax:856-496-6121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness