Provider Information for 1780391649
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BARRY WAYNE CAMP LPC
Sex: Male
NPI: 1780391649
Last Updated: 2025-02-10
Certification Date: 2025-02-10
Certification Date: 2025-02-10
Details
| Name | Value | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1780391649 | ||||||||||||||
| Enumeration Date | 2022-10-31 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | YES | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 21991 AL HIGHWAY 117 IDER, AL 35981-4207 United States Phone: 256-687-9517 | Fax: | ||||||||||||||
| Primary Practice Address | 215 GRAND AVE SW FORT PAYNE, AL 35967-1917 United States Phone: 256-279-7716 | Fax: | ||||||||||||||
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