Provider Demographics
NPI:1588712905
Name:CAMERON, PAMELA M (LCSW)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:M
Last Name:CAMERON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 HARDY ST
Mailing Address - Street 2:STE B
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401
Mailing Address - Country:US
Mailing Address - Phone:601-310-6400
Mailing Address - Fax:601-544-0933
Practice Address - Street 1:2104 HARDY ST
Practice Address - Street 2:STE B
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401
Practice Address - Country:US
Practice Address - Phone:601-310-6400
Practice Address - Fax:601-544-0933
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC03761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS800000149Medicare ID - Type Unspecified