Provider Demographics
NPI:1073167797
Name:CAMPBELL, SHELIA DENISE (LPC-A)
Entity Type:Individual
Prefix:
First Name:SHELIA
Middle Name:DENISE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8710 HEARTLEAF RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-3655
Mailing Address - Country:US
Mailing Address - Phone:704-965-9925
Mailing Address - Fax:
Practice Address - Street 1:8401 MEDICAL PLAZA DR STE 360
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-8700
Practice Address - Country:US
Practice Address - Phone:704-208-4458
Practice Address - Fax:866-309-6385
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14794101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional