Provider Demographics
NPI:1881835254
Name:CAMPBELL, GLENN CAMERON
Entity Type:Individual
Prefix:MR
First Name:GLENN
Middle Name:CAMERON
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 E OHIO AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3439
Mailing Address - Country:US
Mailing Address - Phone:760-745-7786
Mailing Address - Fax:760-745-1061
Practice Address - Street 1:910 E OHIO AVE STE 104
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3439
Practice Address - Country:US
Practice Address - Phone:760-745-7786
Practice Address - Fax:760-745-1061
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)