Provider Demographics
NPI:1659565265
Name:ALTHOF-CAMPBELL, NICOLE DIANE (LISW-S)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:DIANE
Last Name:ALTHOF-CAMPBELL
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3769 AYLESBORO AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-1707
Mailing Address - Country:US
Mailing Address - Phone:910-508-8668
Mailing Address - Fax:
Practice Address - Street 1:4760 MADISON RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-1426
Practice Address - Country:US
Practice Address - Phone:513-321-8286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health