Provider Demographics
NPI:1710353180
Name:CAMPBELL, DARLENE MARIE
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:MARIE
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 1:58133 ALTA MESA DR
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-5924
Mailing Address - Country:US
Mailing Address - Phone:760-369-1074
Mailing Address - Fax:760-369-1293
Practice Address - Street 1:58945 BUSINESS CENTER DR
Practice Address - Street 2:SUITE J
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-7307
Practice Address - Country:US
Practice Address - Phone:760-369-1074
Practice Address - Fax:760-369-1293
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)