Provider Demographics
NPI:1891464970
Name:VELLON-ZWAGA, CAMILLA (LCSW)
Entity type:Individual
Prefix:
First Name:CAMILLA
Middle Name:
Last Name:VELLON-ZWAGA
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 1:721 BLUE SKY DR NW STE 5
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-7965
Mailing Address - Country:US
Mailing Address - Phone:608-239-0811
Mailing Address - Fax:608-709-1744
Practice Address - Street 1:6417 ODANA RD.
Practice Address - Street 2:SUITE 5
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719
Practice Address - Country:US
Practice Address - Phone:608-268-6530
Practice Address - Fax:608-709-1744
Is Sole Proprietor?:No
Enumeration Date:2021-09-10
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0176301041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical