Provider Demographics
NPI:1437452083
Name:DAVIS CAMPBELL, MALINDA M (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MALINDA
Middle Name:M
Last Name:DAVIS CAMPBELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:MALINDA
Other - Middle Name:M
Other - Last Name:DAVIS CAMPBELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:3 CLYDE ROAD SUITE 201
Mailing Address - Street 2:CHRISTIAN WELLNESS CENTER OF NJ
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873
Mailing Address - Country:US
Mailing Address - Phone:732-412-7374
Mailing Address - Fax:
Practice Address - Street 1:3 CLYDE ROAD SUITE 201
Practice Address - Street 2:CHRISTIAN WELLNESS CENTER OF NJ
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873
Practice Address - Country:US
Practice Address - Phone:732-412-7374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053384001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical