Provider Demographics
NPI:1710392725
Name:CAMPBELL, NATALIE JAY (LCSW)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:JAY
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 E VISTA WAY STE 1
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-2755
Mailing Address - Country:US
Mailing Address - Phone:760-599-8680
Mailing Address - Fax:
Practice Address - Street 1:2210 E VISTA WAY STE 1
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-2755
Practice Address - Country:US
Practice Address - Phone:760-599-8680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-27
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA373781Medicaid