Provider Demographics
NPI:1578871208
Name:CAMPMAN, JACQUELINE CRISTIANO (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:CRISTIANO
Last Name:CAMPMAN
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 NEW VILLAGE WAY
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-7426
Mailing Address - Country:US
Mailing Address - Phone:910-251-5858
Mailing Address - Fax:910-251-5893
Practice Address - Street 1:2600 NEW VILLAGE WAY
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-7426
Practice Address - Country:US
Practice Address - Phone:910-251-5858
Practice Address - Fax:910-251-5893
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8159101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health