Provider Demographics
NPI:1699029926
Name:CAMPBELL, EDIE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:EDIE
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 FAWN HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062-2819
Mailing Address - Country:US
Mailing Address - Phone:609-970-6281
Mailing Address - Fax:
Practice Address - Street 1:38 FAWN HOLLOW LN
Practice Address - Street 2:
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062-2819
Practice Address - Country:US
Practice Address - Phone:609-970-6281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37F100165400106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist