Provider Demographics
NPI:1699412767
Name:CAMPBELL, LATANYA (MS LPC NBCC)
Entity Type:Individual
Prefix:
First Name:LATANYA
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MS LPC NBCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-4718
Mailing Address - Country:US
Mailing Address - Phone:715-848-5022
Mailing Address - Fax:888-778-6750
Practice Address - Street 1:901 N 6TH ST
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-4718
Practice Address - Country:US
Practice Address - Phone:715-848-5022
Practice Address - Fax:888-778-6750
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-19
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5322-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional