Provider Demographics
NPI:1932564770
Name:CAMPBELL, TASHEA (LPCCS)
Entity Type:Individual
Prefix:
First Name:TASHEA
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LPCCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 W MAIN ST UNIT 902
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-9191
Mailing Address - Country:US
Mailing Address - Phone:614-383-8375
Mailing Address - Fax:614-983-1106
Practice Address - Street 1:102 W MAIN ST UNIT 902
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-9191
Practice Address - Country:US
Practice Address - Phone:614-383-8375
Practice Address - Fax:614-983-1106
Is Sole Proprietor?:No
Enumeration Date:2015-12-21
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1901013-SUPV101YP2500X
OHE.1901013SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0309438Medicaid
OH0013330Medicaid