Provider Demographics
NPI:1922215102
Name:CAMPBELL, JOHN ALEC (CDP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ALEC
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 112TH AVE NE
Mailing Address - Street 2:STE 150
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-2993
Mailing Address - Country:US
Mailing Address - Phone:425-646-7279
Mailing Address - Fax:424-646-7499
Practice Address - Street 1:1800 112TH AVE NE
Practice Address - Street 2:STE 150
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-2993
Practice Address - Country:US
Practice Address - Phone:425-646-7279
Practice Address - Fax:424-646-7499
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00041198101Y00000X
WACP00005051101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)