Provider Demographics
NPI:1881820546
Name:CAMPBELL, LUCYNDA LAURYNNE (CDC I)
Entity Type:Individual
Prefix:
First Name:LUCYNDA
Middle Name:LAURYNNE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:CDC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 INDIAN RIVER RD
Mailing Address - Street 2:
Mailing Address - City:SITKA
Mailing Address - State:AK
Mailing Address - Zip Code:99835-7480
Mailing Address - Country:US
Mailing Address - Phone:907-747-2801
Mailing Address - Fax:
Practice Address - Street 1:701 INDIAN RIVER RD
Practice Address - Street 2:
Practice Address - City:SITKA
Practice Address - State:AK
Practice Address - Zip Code:99835-7480
Practice Address - Country:US
Practice Address - Phone:907-747-2801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3361101YA0400X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)