Provider Demographics
NPI:1043713985
Name:VAN CAMP, LAKSHMI REKHA
Entity type:Individual
Prefix:
First Name:LAKSHMI
Middle Name:REKHA
Last Name:VAN CAMP
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 EBENEZER RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-5303
Mailing Address - Country:US
Mailing Address - Phone:865-606-1681
Mailing Address - Fax:
Practice Address - Street 1:346 EBENEZER RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-5303
Practice Address - Country:US
Practice Address - Phone:865-606-1681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-16
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4214101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4214OtherLPC-MHSP