Provider Demographics
NPI:1275722969
Name:CAMPBELL, LESLIE A (LCSW)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:A
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 1:3815 GEORGIA ST
Mailing Address - Street 2:APT 102
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-7622
Mailing Address - Country:US
Mailing Address - Phone:619-820-7770
Mailing Address - Fax:619-955-8520
Practice Address - Street 1:3815 GEORGIA ST
Practice Address - Street 2:APT 102
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-7614
Practice Address - Country:US
Practice Address - Phone:619-820-7770
Practice Address - Fax:619-955-8520
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 280961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical