Provider Demographics
NPI:1124227749
Name:CAMPBELL, KIMBERLEE DAWN (CADAC-II)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLEE
Middle Name:DAWN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:CADAC-II
Other - Prefix:MRS
Other - First Name:KIMBERLEE
Other - Middle Name:DAWN
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ROTHENBERGER
Mailing Address - Street 1:1701 MISSION AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-7110
Mailing Address - Country:US
Mailing Address - Phone:760-721-2781
Mailing Address - Fax:760-712-3195
Practice Address - Street 1:1701 MISSION AVE STE 310
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-7110
Practice Address - Country:US
Practice Address - Phone:760-721-2781
Practice Address - Fax:760-712-3195
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA370045EN101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)