Provider Demographics
NPI:1619428570
Name:CAMPBELL, DAWN CHRISTINA (MA RI-MHC)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:CHRISTINA
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MA RI-MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 N NOVA RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-4447
Mailing Address - Country:US
Mailing Address - Phone:386-307-4555
Mailing Address - Fax:386-675-6490
Practice Address - Street 1:533 N NOVA RD
Practice Address - Street 2:SUITE 204
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-4447
Practice Address - Country:US
Practice Address - Phone:386-307-4555
Practice Address - Fax:386-675-6490
Is Sole Proprietor?:No
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH14809101YM0800X
FLCWCM P100112171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator