Provider Demographics
NPI:1568546448
Name:CAMPBELL, ELIZABETH D (LLMFT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:D
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LLMFT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ANN
Other - Last Name:DICKERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26555 EVERGREEN RD STE 870
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-4239
Mailing Address - Country:US
Mailing Address - Phone:248-430-0594
Mailing Address - Fax:
Practice Address - Street 1:26555 EVERGREEN RD STE 870
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-4239
Practice Address - Country:US
Practice Address - Phone:248-430-0594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MI106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health