Provider Demographics
NPI:1255543369
Name:CAMPBELL, AUDREY J (BSW LSW)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:J
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:BSW LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4495 W HACIENDA AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-1541
Mailing Address - Country:US
Mailing Address - Phone:702-247-6247
Mailing Address - Fax:
Practice Address - Street 1:4495 W HACIENDA AVE STE 7
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-1541
Practice Address - Country:US
Practice Address - Phone:702-385-5331
Practice Address - Fax:702-385-5678
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4465-S104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker