Provider Demographics
NPI:1003136193
Name:NANCY E CAMPBELL, LLC
Entity Type:Organization
Organization Name:NANCY E CAMPBELL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, NANCY E CAMPBELL, LLC
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:E
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:520-878-7857
Mailing Address - Street 1:14110 N CROOKED CREEK DR.
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85658
Mailing Address - Country:US
Mailing Address - Phone:520-878-7857
Mailing Address - Fax:520-572-2049
Practice Address - Street 1:2230 E. SPEEDWAY BLVD., SUITE 100
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719
Practice Address - Country:US
Practice Address - Phone:520-878-7857
Practice Address - Fax:520-572-2049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-11
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0158471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty