Provider Demographics
NPI:1376868562
Name:CAMPBELL, BRENDA STEPTOE (MSW, PROVISIONAL GSW)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:STEPTOE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MSW, PROVISIONAL GSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15665 BACCA ST
Mailing Address - Street 2:
Mailing Address - City:PONCHATOULA
Mailing Address - State:LA
Mailing Address - Zip Code:70454-9437
Mailing Address - Country:US
Mailing Address - Phone:985-981-8884
Mailing Address - Fax:
Practice Address - Street 1:1520 THOMAS H DELPIT DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70802-6626
Practice Address - Country:US
Practice Address - Phone:225-389-0138
Practice Address - Fax:225-382-2358
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10706101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA00000OtherN/A