Provider Demographics
NPI:1871908202
Name:CAMACHO, LAVINA TERESE LEON GUERRERO (MS, MFT-136)
Entity type:Individual
Prefix:MS
First Name:LAVINA TERESE
Middle Name:LEON GUERRERO
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:MS, MFT-136
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 NALAO PLACE
Mailing Address - Street 2:
Mailing Address - City:BARRIGADA
Mailing Address - State:GU
Mailing Address - Zip Code:96913
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:194 HERNAN CORTEZ AVENUE
Practice Address - Street 2:DPHSS PROJECT KARINU SUITE 208
Practice Address - City:HAGATNA
Practice Address - State:GU
Practice Address - Zip Code:96910
Practice Address - Country:US
Practice Address - Phone:671-478-5418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUMFT-136106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist