Provider Demographics
NPI:1508237165
Name:CAMPBELL, ELAINE (LPC)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 BRIDGE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PEQUEA
Mailing Address - State:PA
Mailing Address - Zip Code:17565-9300
Mailing Address - Country:US
Mailing Address - Phone:717-917-7183
Mailing Address - Fax:
Practice Address - Street 1:337 BRIDGE VALLEY RD
Practice Address - Street 2:
Practice Address - City:PEQUEA
Practice Address - State:PA
Practice Address - Zip Code:17565-9300
Practice Address - Country:US
Practice Address - Phone:717-917-7183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008387101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional