Provider Demographics
NPI:1619758059
Name:CAMPBELL, SAVANA ROSE
Entity Type:Individual
Prefix:
First Name:SAVANA
Middle Name:ROSE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
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 815
Mailing Address - Street 2:
Mailing Address - City:HAIKU
Mailing Address - State:HI
Mailing Address - Zip Code:96708-0815
Mailing Address - Country:US
Mailing Address - Phone:928-632-2121
Mailing Address - Fax:
Practice Address - Street 1:65 E WAIPIO RD
Practice Address - Street 2:
Practice Address - City:HAIKU
Practice Address - State:HI
Practice Address - Zip Code:96708-5725
Practice Address - Country:US
Practice Address - Phone:928-632-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health