Provider Demographics
NPI:1073653812
Name:FAREWELL CAMPBELL, JOANNA M (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:M
Last Name:FAREWELL CAMPBELL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 WATERVILLE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH GRAFTON
Mailing Address - State:MA
Mailing Address - Zip Code:01536-1823
Mailing Address - Country:US
Mailing Address - Phone:508-839-6682
Mailing Address - Fax:
Practice Address - Street 1:29 PINE ST
Practice Address - Street 2:GB WELLS CENTER
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550-1823
Practice Address - Country:US
Practice Address - Phone:508-765-9167
Practice Address - Fax:508-764-2462
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5737101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor