Provider Demographics
NPI:1649471673
Name:CAMPBELL, JANICE FLUELLEN (MAC, LAC, ADS)
Entity type:Individual
Prefix:MS
First Name:JANICE
Middle Name:FLUELLEN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MAC, LAC, ADS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 S EAST AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-2210
Mailing Address - Country:US
Mailing Address - Phone:410-558-2124
Mailing Address - Fax:
Practice Address - Street 1:1106 N CHARLES ST
Practice Address - Street 2:SUITE 302
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-5557
Practice Address - Country:US
Practice Address - Phone:410-710-7094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU001508171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist