Provider Demographics
NPI:1053673913
Name:DAVIS, CAMILLE A (LCSW, LSCSW)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:A
Last Name:DAVIS
Suffix:
Gender:
Credentials:LCSW, LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 SE 3RD ST STE 206
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-2322
Mailing Address - Country:US
Mailing Address - Phone:913-214-1769
Mailing Address - Fax:816-693-2723
Practice Address - Street 1:9 SE 3RD ST STE 206
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-2322
Practice Address - Country:US
Practice Address - Phone:316-807-1365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20240026251041C0700X
KS058311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical