Provider Demographics
NPI:1669543377
Name:CAMPBELL, JOHN T JR (DMIN)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:T
Last Name:CAMPBELL
Suffix:JR
Gender:M
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 206
Mailing Address - Street 2:
Mailing Address - City:BREVARD
Mailing Address - State:NC
Mailing Address - Zip Code:28712-0206
Mailing Address - Country:US
Mailing Address - Phone:828-884-7154
Mailing Address - Fax:
Practice Address - Street 1:4 W MAIN ST
Practice Address - Street 2:SUITE #8
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-3634
Practice Address - Country:US
Practice Address - Phone:828-884-7154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC63101YP1600X
NC5276101YP2500X
GA003049101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC141E7OtherBCBSNC PROVIDER NUMBER