Provider Demographics
NPI:1609931419
Name:CAMPBELL, KIRK CHARLES (LCDC)
Entity Type:Individual
Prefix:MR
First Name:KIRK
Middle Name:CHARLES
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 130938
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77219-0938
Mailing Address - Country:US
Mailing Address - Phone:713-528-6720
Mailing Address - Fax:713-520-6720
Practice Address - Street 1:6699 PORTWEST DRIVE
Practice Address - Street 2:SUITE 140
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-8002
Practice Address - Country:US
Practice Address - Phone:713-528-6720
Practice Address - Fax:713-520-6720
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7728101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)