Provider Demographics
NPI:1033621081
Name:CAMPBELL, TRESA
Entity Type:Individual
Prefix:
First Name:TRESA
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4146 LAKEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48215-2306
Mailing Address - Country:US
Mailing Address - Phone:313-921-9403
Mailing Address - Fax:313-921-9412
Practice Address - Street 1:4146 LAKEWOOD ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48215-2306
Practice Address - Country:US
Practice Address - Phone:313-921-9403
Practice Address - Fax:313-921-9412
Is Sole Proprietor?:No
Enumeration Date:2017-10-31
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)