Provider Demographics
NPI:1346426814
Name:CAMPBELL, AMANDA CALDWELL (MA)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:CALDWELL
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3090 YUKON DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:TN
Mailing Address - Zip Code:38002-4901
Mailing Address - Country:US
Mailing Address - Phone:901-251-5000
Mailing Address - Fax:901-251-5001
Practice Address - Street 1:3320 BROTHER BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38133-8950
Practice Address - Country:US
Practice Address - Phone:901-251-5000
Practice Address - Fax:901-251-5001
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional