Individual
CAMERON GRACE HOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3760 LAVISTA RD STE 102, TUCKER, GA 30084-5622
(770) 375-8124
Mailing address
139 MOCKINGBIRD LN, DECATUR, GA 30030-1160
(919) 451-3877
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY004217
GA
Other
Enumeration date
05/25/2024
Last updated
05/25/2024
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