Basic Information
| Provider Information | |||||||||
| NPI: | 1124116686 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAMMACK | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | GUY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1603 SHERWOOD RD | ||||||||
| Address2: | |||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209023960 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015928447 | ||||||||
| FaxNumber: | 3016778967 | ||||||||
| Practice Location | |||||||||
| Address1: | 2481 LLEWELLYN AVE | ||||||||
| Address2: | BHCS, USA MEDDAC | ||||||||
| City: | FORT MEADE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207555800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016778895 | ||||||||
| FaxNumber: | 3016778957 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2006 | ||||||||
| LastUpdateDate: | 07/25/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 3057 | AZ | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.