Provider Demographics
NPI:1811463623
Name:CAMPBELL, CHERYL ANN (LICSW, CDP)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LICSW, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 E MISSION AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1816
Mailing Address - Country:US
Mailing Address - Phone:509-232-5766
Mailing Address - Fax:
Practice Address - Street 1:1313 N 13TH AVE
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-8817
Practice Address - Country:US
Practice Address - Phone:509-526-6506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60212001101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)