Provider Demographics
NPI:1073952594
Name:CAMPBELL, ANNE E (PHD)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:E
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34024 SCHULTE DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48335-4163
Mailing Address - Country:US
Mailing Address - Phone:248-363-2850
Mailing Address - Fax:
Practice Address - Street 1:8898 COMMERCE RD
Practice Address - Street 2:SUITE 3A
Practice Address - City:COMMERCE TWP
Practice Address - State:MI
Practice Address - Zip Code:48382-4485
Practice Address - Country:US
Practice Address - Phone:248-363-2850
Practice Address - Fax:800-380-6809
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010948103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent