Provider Demographics
NPI:1750866570
Name:CAMPBELL, ANGELA CHERMAYNE
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:CHERMAYNE
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 1:565 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-4014
Mailing Address - Country:US
Mailing Address - Phone:872-210-4778
Mailing Address - Fax:
Practice Address - Street 1:565 HOWARD ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-4014
Practice Address - Country:US
Practice Address - Phone:872-210-4778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-27
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.013428101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional