Provider Demographics
NPI:1154027050
Name:COLEMAN, CAMILLE (LSW)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8383 NE SANDY BLVD, SUITE 440
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220
Mailing Address - Country:US
Mailing Address - Phone:971-373-4041
Mailing Address - Fax:973-373-5285
Practice Address - Street 1:8383 NE SANDY BLVD, SUITE 440
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220
Practice Address - Country:US
Practice Address - Phone:971-373-4041
Practice Address - Fax:973-373-5285
Is Sole Proprietor?:No
Enumeration Date:2023-02-01
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA143651041C0700X
IL1501097491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical