Provider Demographics
NPI:1225139983
Name:CAMPBELL, RENEE SUSANNE (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:SUSANNE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:109 BROOK HOLLOW CT
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-4932
Mailing Address - Country:US
Mailing Address - Phone:919-308-9024
Mailing Address - Fax:
Practice Address - Street 1:2315 MYRON DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-3344
Practice Address - Country:US
Practice Address - Phone:919-576-6018
Practice Address - Fax:919-784-9184
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4486101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102502Medicaid