Provider Demographics
NPI:1023807757
Name:CAMAC, STACEY (LAC)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:CAMAC
Suffix:
Gender:
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:376 SWEDESBORO RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLINVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08322-3435
Mailing Address - Country:US
Mailing Address - Phone:856-777-4502
Mailing Address - Fax:
Practice Address - Street 1:5 CARROLL AVE STE 5
Practice Address - Street 2:
Practice Address - City:PENNSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08070-2129
Practice Address - Country:US
Practice Address - Phone:856-209-3799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00768600101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health