Provider Demographics
NPI:1093860371
Name:CAMPBELL-FLINT, MAXINE ELIZABETH (PHD, MP)
Entity Type:Individual
Prefix:DR
First Name:MAXINE
Middle Name:ELIZABETH
Last Name:CAMPBELL-FLINT
Suffix:
Gender:F
Credentials:PHD, MP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7725 HANKS DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70812-4004
Mailing Address - Country:US
Mailing Address - Phone:225-719-1988
Mailing Address - Fax:888-719-5854
Practice Address - Street 1:412 N 4TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70802-5523
Practice Address - Country:US
Practice Address - Phone:225-719-1988
Practice Address - Fax:888-719-5854
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMP.000028103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1563439Medicaid