Provider Demographics
NPI:1861225013
Name:CAMUS, MONA ALICIA (SUDPT)
Entity type:Individual
Prefix:
First Name:MONA
Middle Name:ALICIA
Last Name:CAMUS
Suffix:
Gender:F
Credentials:SUDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 COMMERCE AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-3096
Mailing Address - Country:US
Mailing Address - Phone:360-423-2806
Mailing Address - Fax:
Practice Address - Street 1:1302 COMMERCE AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3096
Practice Address - Country:US
Practice Address - Phone:360-423-2806
Practice Address - Fax:360-423-5128
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61548191101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)