Provider Demographics
NPI:1215464722
Name:WELLINGTON WALLS, CAMEEL RACHAEL
Entity type:Individual
Prefix:
First Name:CAMEEL
Middle Name:RACHAEL
Last Name:WELLINGTON WALLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12260 SW 53RD ST # 211
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33330-3320
Mailing Address - Country:US
Mailing Address - Phone:954-499-5794
Mailing Address - Fax:954-252-4844
Practice Address - Street 1:12260 SW 53RD ST # 211
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33330-3320
Practice Address - Country:US
Practice Address - Phone:954-499-5794
Practice Address - Fax:954-252-4844
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst