Provider Demographics
NPI:1780869131
Name:CAMPBELL, RITA ANNE (MFT)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:ANNE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:RITA
Other - Middle Name:HEYN
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:973 VALE TERRACE
Mailing Address - Street 2:#206
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-5254
Mailing Address - Country:US
Mailing Address - Phone:619-526-7110
Mailing Address - Fax:760-753-5275
Practice Address - Street 1:973 VALE TERRACE
Practice Address - Street 2:#206
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-5254
Practice Address - Country:US
Practice Address - Phone:619-526-7110
Practice Address - Fax:760-753-5275
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC27066106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist