Provider Demographics
NPI:1972925618
Name:CAMPBELL, COLLIN ALLEN (LAC,DCCM)
Entity Type:Individual
Prefix:
First Name:COLLIN
Middle Name:ALLEN
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:LAC,DCCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 CROSBY VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:EASTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02642-3121
Mailing Address - Country:US
Mailing Address - Phone:773-344-1275
Mailing Address - Fax:
Practice Address - Street 1:76 AIRLINE RD
Practice Address - Street 2:
Practice Address - City:SOUTH DENNIS
Practice Address - State:MA
Practice Address - Zip Code:02660-2583
Practice Address - Country:US
Practice Address - Phone:508-980-3363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-15
Last Update Date:2021-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000772171100000X
IL198.001061171100000X
NY006198-1171100000X
MA287173171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist