Chantal Camarena, RADT

Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Campo, CA

NPI 1114754181 · NPPES record last updated Sep 16, 2024

Key facts

NPI
1114754181
Entity type
Individual (NPI type 1)
Primary specialty
Addiction (Substance Use Disorder) Counselor 101YA0400X
License
R1540700124 (CA)
Practice address
1777 Buckman Springs Rd
Campo, CA 91906-2022
Phone
(619) 478-5696
Fax
(619) 478-2404
NPI assigned
Sep 16, 2024
Sex
Female
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
R1540700124CAMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
San Diego Freedom Ranch, Inc. Past
since Sep 23, 2024
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X R1540700124 CA Yes

Addresses

Primary practice location

1777 Buckman Springs Rd
Campo, CA 91906-2022

Mailing address

1777 Buckman Springs Rd
Campo, CA 91906-2022
Phone (619) 478-5696

Other providers in Campo, CA

All providers in Campo, CA · Addiction (Substance Use Disorder) Counselor in California

Sources for this page

Verify at the official NPI Registry.