Provider Demographics
NPI:1003452293
Name:CAMPBELL, SHARECE NECOLE (LMFT, LPC)
Entity Type:Individual
Prefix:MRS
First Name:SHARECE
Middle Name:NECOLE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LMFT, LPC
Other - Prefix:MISS
Other - First Name:SHARECE
Other - Middle Name:NECOLE
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8225 CROSS PARK DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78710-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:525 SHENLEY DR
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-2233
Practice Address - Country:US
Practice Address - Phone:716-392-5304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-21
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF001057106H00000X
NC2461106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist