Provider Demographics
NPI:1205203486
Name:CAROL CAMPBELL LMFT
Entity Type:Organization
Organization Name:CAROL CAMPBELL LMFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:860-984-3190
Mailing Address - Street 1:18 ONECO ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-3440
Mailing Address - Country:US
Mailing Address - Phone:860-984-3190
Mailing Address - Fax:
Practice Address - Street 1:18 ONECO ST
Practice Address - Street 2:SUITE 3
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-3440
Practice Address - Country:US
Practice Address - Phone:860-984-3190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001463106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty