Provider Demographics
NPI:1578602710
Name:CAMPBELL, CATHY A (LICSW)
Entity Type:Individual
Prefix:MS
First Name:CATHY
Middle Name:A
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 E YAKIMA AVE
Mailing Address - Street 2:SUITE 380
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-5407
Mailing Address - Country:US
Mailing Address - Phone:509-961-0775
Mailing Address - Fax:509-457-2756
Practice Address - Street 1:402 E YAKIMA AVE
Practice Address - Street 2:SUITE 380
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-5407
Practice Address - Country:US
Practice Address - Phone:509-961-0775
Practice Address - Fax:509-457-2756
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000078501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8943225OtherL&I CRIME VICTIM COMPENSA
WA8943225OtherL&I CRIME VICTIM COMPENSA