Provider Demographics
NPI:1902406747
Name:ABIGAIL A CAMPBELL
Entity Type:Organization
Organization Name:ABIGAIL A CAMPBELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:765-434-1113
Mailing Address - Street 1:2660 SEA BISCUIT LN
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-5093
Mailing Address - Country:US
Mailing Address - Phone:765-434-1113
Mailing Address - Fax:765-395-9010
Practice Address - Street 1:2660 SEA BISCUIT LN
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-5093
Practice Address - Country:US
Practice Address - Phone:765-434-1113
Practice Address - Fax:765-395-9010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty