Provider Demographics
NPI:1669700084
Name:CAMPBELL, JENNIFER C (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:C
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6602 DORRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-3085
Mailing Address - Country:US
Mailing Address - Phone:910-799-8257
Mailing Address - Fax:
Practice Address - Street 1:5919 OLEANDER DR
Practice Address - Street 2:STE 104, BLDG 2
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4780
Practice Address - Country:US
Practice Address - Phone:910-792-9888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0066221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical