Provider Demographics
NPI:1841873916
Name:CAMPBELL, SHAQUESHA D (LCSWA)
Entity type:Individual
Prefix:
First Name:SHAQUESHA
Middle Name:D
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8705 CREEK TRAIL LN APT 513
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-6554
Mailing Address - Country:US
Mailing Address - Phone:984-204-3990
Mailing Address - Fax:
Practice Address - Street 1:8705 CREEK TRAIL LN APT 513
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-6554
Practice Address - Country:US
Practice Address - Phone:984-204-3990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0158781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical