Provider Demographics
NPI:1215940515
Name:CAMP, CHARISSA C (PHD, ABPP)
Entity type:Individual
Prefix:DR
First Name:CHARISSA
Middle Name:C
Last Name:CAMP
Suffix:
Gender:F
Credentials:PHD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6263 POPLAR AVE
Mailing Address - Street 2:SUITE 932
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-4738
Mailing Address - Country:US
Mailing Address - Phone:901-761-1511
Mailing Address - Fax:901-761-1116
Practice Address - Street 1:6263 POPLAR AVE
Practice Address - Street 2:SUITE 932
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4738
Practice Address - Country:US
Practice Address - Phone:901-761-1511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP2077103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3982928Medicaid
TN4108657OtherBC/BS OF TN PIN
TN3982928Medicaid