Provider Demographics
NPI:1285840652
Name:CAMPBELL, LISA POPE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:POPE
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 1:2070 BUFORD HWY
Mailing Address - Street 2:STE 2D
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-6079
Mailing Address - Country:US
Mailing Address - Phone:770-271-9442
Mailing Address - Fax:770-271-8939
Practice Address - Street 1:2070 BUFORD HWY
Practice Address - Street 2:STE 2D
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-6079
Practice Address - Country:US
Practice Address - Phone:770-271-9442
Practice Address - Fax:770-271-8939
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0001864106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist