Provider Demographics
NPI:1528436433
Name:PROCTOR, SUZANNE CAMILLE (CAMILLE PROCTOR)
Entity type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:CAMILLE
Last Name:PROCTOR
Suffix:
Gender:F
Credentials:CAMILLE PROCTOR
Other - Prefix:MS
Other - First Name:CAMILLE
Other - Middle Name:
Other - Last Name:PROCTOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CAMILLE PROCTOR
Mailing Address - Street 1:425 E 14 MILE RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-2023
Mailing Address - Country:US
Mailing Address - Phone:313-444-9035
Mailing Address - Fax:
Practice Address - Street 1:425 E 14 MILE RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-2023
Practice Address - Country:US
Practice Address - Phone:313-444-9035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health