Provider Demographics
NPI:1952052201
Name:CAMPBELL-DICKERSON, JONAY JACQUEL
Entity Type:Individual
Prefix:
First Name:JONAY
Middle Name:JACQUEL
Last Name:CAMPBELL-DICKERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2439 MANHATTAN BLVD STE 308
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-5396
Mailing Address - Country:US
Mailing Address - Phone:504-366-5265
Mailing Address - Fax:
Practice Address - Street 1:2439 MANHATTAN BLVD STE 308
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-5396
Practice Address - Country:US
Practice Address - Phone:504-366-5265
Practice Address - Fax:504-366-5260
Is Sole Proprietor?:No
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator