Provider Demographics
NPI:1437267481
Name:CAMPBELL, SALLIE (LISW-CP, LMFT)
Entity Type:Individual
Prefix:
First Name:SALLIE
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LISW-CP, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 NIGHT HERON DR
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-4106
Mailing Address - Country:US
Mailing Address - Phone:843-224-8315
Mailing Address - Fax:843-881-3092
Practice Address - Street 1:3 GAMECOCK AVE
Practice Address - Street 2:SUITE 304-B
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-3378
Practice Address - Country:US
Practice Address - Phone:843-224-8315
Practice Address - Fax:843-881-3092
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC63104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q32108Medicare UPIN