Provider Demographics
NPI:1942923735
Name:BLUE CAMPBELL AND ASSOCIATES LLC
Entity Type:Organization
Organization Name:BLUE CAMPBELL AND ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUE-CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC-S
Authorized Official - Phone:443-904-8216
Mailing Address - Street 1:521 GARRISON FOREST RD
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4010
Mailing Address - Country:US
Mailing Address - Phone:443-904-8216
Mailing Address - Fax:
Practice Address - Street 1:2645 WILKENS AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223-3314
Practice Address - Country:US
Practice Address - Phone:443-904-8216
Practice Address - Fax:443-708-1443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDMCOMedicaid