Provider Demographics
NPI:1669950515
Name:CAMPBELL, ANDREW (LMSW)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:MR
Other - First Name:ANDREW
Other - Middle Name:
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:852 CRAWFORD ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39203-1011
Mailing Address - Country:US
Mailing Address - Phone:601-983-8230
Mailing Address - Fax:
Practice Address - Street 1:850 E RIVER PL
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-3443
Practice Address - Country:US
Practice Address - Phone:601-624-3749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSM9298104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker