Provider Demographics
NPI:1144654013
Name:MOUNT, CAMERON DAVID (MS)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:DAVID
Last Name:MOUNT
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:997 EAGLES NEST CIR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30116-5496
Mailing Address - Country:US
Mailing Address - Phone:678-571-0148
Mailing Address - Fax:
Practice Address - Street 1:997 EAGLES NEST CIR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30116-5496
Practice Address - Country:US
Practice Address - Phone:678-571-0148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006537101YP2500X
GAMFT001135106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional