Provider Demographics
NPI:1356503361
Name:CAMPBELL, RACHELLE KRISTEN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:RACHELLE
Middle Name:KRISTEN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3651 ACADIA DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48360-2723
Mailing Address - Country:US
Mailing Address - Phone:248-978-5625
Mailing Address - Fax:
Practice Address - Street 1:6303 26 MILE RD STE 120
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MI
Practice Address - Zip Code:48094-3851
Practice Address - Country:US
Practice Address - Phone:248-978-5625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009560101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional