Provider Demographics
NPI:1134327638
Name:CAMPBELL, WILLEMIJN JOHANNA (MS)
Entity Type:Individual
Prefix:MRS
First Name:WILLEMIJN
Middle Name:JOHANNA
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 PACIFIC ST APT 204
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-2477
Mailing Address - Country:US
Mailing Address - Phone:310-857-6711
Mailing Address - Fax:
Practice Address - Street 1:501 PACIFIC ST APT 204
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-2477
Practice Address - Country:US
Practice Address - Phone:310-456-4937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF53261106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist