Provider Demographics
NPI:1376785402
Name:CAMPBELL, ADELAIDA (MA, LPC,)
Entity Type:Individual
Prefix:MRS
First Name:ADELAIDA
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MA, LPC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 HAWK PKWY UNIT 317
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-6472
Mailing Address - Country:US
Mailing Address - Phone:970-403-7656
Mailing Address - Fax:877-501-6875
Practice Address - Street 1:1404 HAWK PKWY UNIT 317
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-6472
Practice Address - Country:US
Practice Address - Phone:970-403-7656
Practice Address - Fax:877-501-6875
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-03
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3262101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional