Provider Demographics
NPI:1578074548
Name:CAMPBELL, FREIDA N (LCADC)
Entity Type:Individual
Prefix:
First Name:FREIDA
Middle Name:N
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2374 DUNDONNELL DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-2524
Mailing Address - Country:US
Mailing Address - Phone:270-860-0628
Mailing Address - Fax:
Practice Address - Street 1:618 N. GREEN STREET
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-4242
Practice Address - Country:US
Practice Address - Phone:270-826-8314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY164700101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)