Provider Demographics
NPI:1740220672
Name:CAMPBELL, MICHAEL A (LCSWC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21629
Mailing Address - Country:US
Mailing Address - Phone:410-479-3800
Mailing Address - Fax:410-479-0052
Practice Address - Street 1:606 SUNNYSIDE AVE
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:MD
Practice Address - Zip Code:21629
Practice Address - Country:US
Practice Address - Phone:410-479-3800
Practice Address - Fax:410-479-0052
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03649104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD566L823CMedicare ID - Type Unspecified