Provider Demographics
NPI:1437770260
Name:CAMPBELL-JACKSON, ZINA L (LCPC)
Entity Type:Individual
Prefix:
First Name:ZINA
Middle Name:L
Last Name:CAMPBELL-JACKSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1732 DEL MIRA DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-2608
Mailing Address - Country:US
Mailing Address - Phone:773-368-7702
Mailing Address - Fax:
Practice Address - Street 1:1785 E SAHARA AVE STE 225
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3798
Practice Address - Country:US
Practice Address - Phone:702-486-7742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-04
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.013956101YP2500X
NVCP5289-R101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional