Provider Demographics
NPI:1124116686
Name:CAMMACK, MICHAEL GUY (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GUY
Last Name:CAMMACK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1603 SHERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-3960
Mailing Address - Country:US
Mailing Address - Phone:301-592-8447
Mailing Address - Fax:301-677-8967
Practice Address - Street 1:2481 LLEWELLYN AVE
Practice Address - Street 2:BHCS, USA MEDDAC
Practice Address - City:FORT MEADE
Practice Address - State:MD
Practice Address - Zip Code:20755-5800
Practice Address - Country:US
Practice Address - Phone:301-677-8895
Practice Address - Fax:301-677-8957
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical