Individual
CAMILLE BUCKALLEW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
730 MEDICAL CENTER CT, CHULA VISTA, CA 91911-6618
(619) 591-5740
Mailing address
10662 CANYON LAKE DR, SAN DIEGO, CA 92131-1266
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
CA
101YM0800X
Mental Health Counselor
—
—
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
11/22/2021
Last updated
06/16/2023
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