Provider Demographics
NPI:1588879803
Name:CAMERON, WILLIE ROY (LPC)
Entity type:Individual
Prefix:MR
First Name:WILLIE
Middle Name:ROY
Last Name:CAMERON
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 S MAIN ST STE 2032H
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-3599
Mailing Address - Country:US
Mailing Address - Phone:678-435-7212
Mailing Address - Fax:
Practice Address - Street 1:804 COMMERCE BLVD
Practice Address - Street 2:STE-A12-14
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30296-7198
Practice Address - Country:US
Practice Address - Phone:770-994-8960
Practice Address - Fax:770-994-8967
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004463101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty