Provider Demographics
NPI:1649338187
Name:BERNAL, CAMILLE ANN (LMPT LPC)
Entity type:Individual
Prefix:MRS
First Name:CAMILLE
Middle Name:ANN
Last Name:BERNAL
Suffix:
Gender:F
Credentials:LMPT LPC
Other - Prefix:MRS
Other - First Name:CAMILLE
Other - Middle Name:ANN
Other - Last Name:MAZZEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT LPC
Mailing Address - Street 1:1908 EASTWOOD ROAD
Mailing Address - Street 2:SUITE 221
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403
Mailing Address - Country:US
Mailing Address - Phone:910-256-5519
Mailing Address - Fax:910-796-0886
Practice Address - Street 1:1908 EASTWOOD ROAD
Practice Address - Street 2:SUITE 221
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403
Practice Address - Country:US
Practice Address - Phone:910-256-5519
Practice Address - Fax:910-796-0886
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2908101YP2500X
NC731106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist