Provider Demographics
NPI:1093509614
Name:FOULKS, CAMERON MICHAEL (LPC)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:MICHAEL
Last Name:FOULKS
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 ANDOVER CT
Mailing Address - Street 2:
Mailing Address - City:SHARPSBURG
Mailing Address - State:GA
Mailing Address - Zip Code:30277-6914
Mailing Address - Country:US
Mailing Address - Phone:770-328-8399
Mailing Address - Fax:
Practice Address - Street 1:110 LORRIE CT
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-3807
Practice Address - Country:US
Practice Address - Phone:443-477-7213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC015630101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health