Provider Demographics
NPI:1437705670
Name:CAMPBELL SR, AFTON (LMSW)
Entity Type:Individual
Prefix:
First Name:AFTON
Middle Name:
Last Name:CAMPBELL SR
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-4137
Mailing Address - Country:US
Mailing Address - Phone:208-585-3375
Mailing Address - Fax:
Practice Address - Street 1:923 GRANT ST
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-4137
Practice Address - Country:US
Practice Address - Phone:208-585-3375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-38866101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health