Provider Demographics
NPI:1174831317
Name:CAMPBELL, KIMBERLY R (LCSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:R
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4806 KUMQUAT DR
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33319-3528
Mailing Address - Country:US
Mailing Address - Phone:919-332-6326
Mailing Address - Fax:
Practice Address - Street 1:4806 KUMQUAT DR
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33319-3528
Practice Address - Country:US
Practice Address - Phone:919-332-6326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-22
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL133821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical