Provider Demographics
NPI:1063860443
Name:CAMPBELL, MARY MELISSA (LAC, LMT)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:MELISSA
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:769 ATLANTIC CITY BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08721-2540
Mailing Address - Country:US
Mailing Address - Phone:732-664-9220
Mailing Address - Fax:
Practice Address - Street 1:769 ATLANTIC CITY BLVD STE 6
Practice Address - Street 2:
Practice Address - City:BAYVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08721-2540
Practice Address - Country:US
Practice Address - Phone:732-664-9220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-26
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ117900171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist