Provider Demographics
NPI:1265867220
Name:CAMPBELL, ELANA CARISSA (MSW, LCSWA)
Entity Type:Individual
Prefix:MRS
First Name:ELANA
Middle Name:CARISSA
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:MS
Other - First Name:ELANA
Other - Middle Name:CARISSA
Other - Last Name:ZIPKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSWA
Mailing Address - Street 1:PO BOX 8241
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27835-8241
Mailing Address - Country:US
Mailing Address - Phone:252-355-5111
Mailing Address - Fax:252-355-1088
Practice Address - Street 1:204 E ARLINGTON BLVD
Practice Address - Street 2:SUITE L
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5022
Practice Address - Country:US
Practice Address - Phone:252-355-5111
Practice Address - Fax:252-355-1088
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP008124104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker