Provider Demographics
NPI:1063569796
Name:PEARSON-CAFFERTY, CAMILLA J (LCPC)
Entity type:Individual
Prefix:MS
First Name:CAMILLA
Middle Name:J
Last Name:PEARSON-CAFFERTY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 N LAKES PLACE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-5939
Mailing Address - Country:US
Mailing Address - Phone:208-342-2273
Mailing Address - Fax:208-893-5484
Practice Address - Street 1:1910 N LAKES PLACE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-5939
Practice Address - Country:US
Practice Address - Phone:208-342-2273
Practice Address - Fax:208-893-5484
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-3619101YM0800X
IDLCPC-4254101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health