Provider Demographics
NPI:1811728637
Name:CAMPBELL, LOGAN W (LCSWA)
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:W
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 POINTER PL
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-4770
Mailing Address - Country:US
Mailing Address - Phone:804-892-5001
Mailing Address - Fax:
Practice Address - Street 1:307 BEECH ST
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-2818
Practice Address - Country:US
Practice Address - Phone:252-495-0404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0205971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical