Provider Demographics
NPI:1083151120
Name:RHYNES-CAMPBELL, CARLA S (RCSWI)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:S
Last Name:RHYNES-CAMPBELL
Suffix:
Gender:F
Credentials:RCSWI
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:S
Other - Last Name:RHYNES-CAMPBELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RCSWI
Mailing Address - Street 1:787 BROWN ST
Mailing Address - Street 2:
Mailing Address - City:CHIPLEY
Mailing Address - State:FL
Mailing Address - Zip Code:32428-2109
Mailing Address - Country:US
Mailing Address - Phone:321-213-7047
Mailing Address - Fax:
Practice Address - Street 1:787 BROWN ST
Practice Address - Street 2:
Practice Address - City:CHIPLEY
Practice Address - State:FL
Practice Address - Zip Code:32428-2109
Practice Address - Country:US
Practice Address - Phone:321-213-7047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL65281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical