Provider Demographics
NPI:1063694404
Name:KAMEYAMA, IHORI (LPC)
Entity type:Individual
Prefix:
First Name:IHORI
Middle Name:
Last Name:KAMEYAMA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 745
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30459-0745
Mailing Address - Country:US
Mailing Address - Phone:912-764-6906
Mailing Address - Fax:912-764-3252
Practice Address - Street 1:150 MEMORIAL DR.
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30453
Practice Address - Country:US
Practice Address - Phone:912-557-6794
Practice Address - Fax:912-557-6817
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004585101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional