Provider Demographics
NPI:1083820047
Name:CAMPBELL, JOANNA LESLIE (LCPC-C)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:LESLIE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LCPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 NAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3319
Mailing Address - Country:US
Mailing Address - Phone:207-990-0431
Mailing Address - Fax:
Practice Address - Street 1:20 LABARCA LN
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-2645
Practice Address - Country:US
Practice Address - Phone:207-990-5470
Practice Address - Fax:207-990-5470
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL3104101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional