Provider Demographics
NPI:1780223917
Name:CAMPBELL, LENISHA NICOLE (MSN, PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:LENISHA
Middle Name:NICOLE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MSN, PMHNP
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Other - First Name:
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Mailing Address - Street 1:4605 MACCORKLE AVE SW
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1311
Mailing Address - Country:US
Mailing Address - Phone:304-414-4800
Mailing Address - Fax:304-414-4801
Practice Address - Street 1:500 POPLAR ST STE 204
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1472
Practice Address - Country:US
Practice Address - Phone:304-414-2895
Practice Address - Fax:304-414-2898
Is Sole Proprietor?:No
Enumeration Date:2020-01-06
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV110788363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health