Individual
CAMERON ANTTWAN BIRMINGHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1825 S BROOKSTONE VILLAGE DR, INDEPENDENCE, MO 64057
(816) 216-0143
Mailing address
1825 S BROOKSTONE VILLAGE DR, APT 203, INDEPENDENCE, MO 64057
(816) 216-0143
Taxonomy
Speciality
Code
Description
License number
State
101200000X
Drama Therapist
A176245003
MO
101Y00000X
Counselor
Primary
A176245003
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
487149633
N/A
—
Enumeration date
05/19/2021
Last updated
05/19/2021
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