Provider Demographics
NPI:1235553645
Name:CAMPBELL, MARTHA (LPC, LCDCIII)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LPC, LCDCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1946 N 13TH ST STE 420
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-7264
Mailing Address - Country:US
Mailing Address - Phone:419-720-9247
Mailing Address - Fax:419-720-0304
Practice Address - Street 1:1946 N 13TH ST STE 420
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-7264
Practice Address - Country:US
Practice Address - Phone:419-720-9247
Practice Address - Fax:419-720-0304
Is Sole Proprietor?:No
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0005211101Y00000X
OH081220101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2963990Medicaid