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Certified Provider Details:
| PROVIDER NUMBER: | 490045 |
| AGENCY NAME: | Camcare Health Ed & Research |
| CONTACT NAME: | Rose-Anne Prince |
| ADDRESS: | 3110 McCorkle Ave. SE |
| CITY: | Charleston |
| STATE: | WV |
| ZIP: | 25304 |
| PHONE: | (304) 388-9963 |
| WEB SITE: | www.camcinstitute.org |
| EMAIL ADDRESS: | roseann.prince@camc.org |
| BSW/MSW NAME: | Lisa D Jones |
| DUE TO RECERTIFY DATE: | 7/1/2010 |
| COMMENTS: |