Provider Demographics
NPI:1407110083
Name:CAMACHO, CAROLYN WEATHERLY (LPC)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:WEATHERLY
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:CAROLYN
Other - Middle Name:WEATHERLY
Other - Last Name:SCHLEICHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:835 E 65TH ST
Mailing Address - Street 2:STE 106
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4421
Mailing Address - Country:US
Mailing Address - Phone:912-692-0425
Mailing Address - Fax:912-352-4361
Practice Address - Street 1:835 E 65TH ST
Practice Address - Street 2:STE 106
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4421
Practice Address - Country:US
Practice Address - Phone:912-692-0425
Practice Address - Fax:912-352-4361
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-28
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health