Provider Demographics
NPI:1659533149
Name:CAMPBELL, SAINTCLARE HICKEY
Entity Type:Individual
Prefix:
First Name:SAINTCLARE
Middle Name:HICKEY
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 1:250 BETTY JO LN
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-2811
Mailing Address - Country:US
Mailing Address - Phone:901-832-8803
Mailing Address - Fax:901-618-2710
Practice Address - Street 1:250 BETTY JO LN
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-2811
Practice Address - Country:US
Practice Address - Phone:901-832-8803
Practice Address - Fax:901-618-2710
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2648101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1522316Medicaid