Provider Demographics
NPI:1366248056
Name:TERRY, CAMILLIA LA'SHA'
Entity type:Individual
Prefix:
First Name:CAMILLIA
Middle Name:LA'SHA'
Last Name:TERRY
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 1:305 MADISON LN
Mailing Address - Street 2:
Mailing Address - City:ODENVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35120-3833
Mailing Address - Country:US
Mailing Address - Phone:205-306-7885
Mailing Address - Fax:
Practice Address - Street 1:305 MADISON LN
Practice Address - Street 2:
Practice Address - City:ODENVILLE
Practice Address - State:AL
Practice Address - Zip Code:35120-3833
Practice Address - Country:US
Practice Address - Phone:205-306-7885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-22
Last Update Date:2025-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician