Provider Demographics
NPI:1043603939
Name:CAMPBELL, EMILY NICOLE (LSW, AASW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:NICOLE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LSW, AASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 HERMOSA DR.
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-4966
Mailing Address - Country:US
Mailing Address - Phone:970-903-7979
Mailing Address - Fax:
Practice Address - Street 1:765 E COLLEGE DR
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5547
Practice Address - Country:US
Practice Address - Phone:970-903-7979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-17
Last Update Date:2017-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099248961041C0700X
CO00099207141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical