Provider Demographics
NPI:1417363656
Name:NONTERAH, CAMILLA (MA)
Entity type:Individual
Prefix:
First Name:CAMILLA
Middle Name:
Last Name:NONTERAH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-7020
Mailing Address - Country:US
Mailing Address - Phone:804-644-9590
Mailing Address - Fax:804-649-2151
Practice Address - Street 1:200 N 22ND ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-7020
Practice Address - Country:US
Practice Address - Phone:804-644-9590
Practice Address - Fax:804-649-2151
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945182Medicaid