Provider Demographics
NPI:1932954146
Name:CAMPBELL-SALAMANCA, KACIE
Entity Type:Individual
Prefix:
First Name:KACIE
Middle Name:
Last Name:CAMPBELL-SALAMANCA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KACIE
Other - Middle Name:
Other - Last Name:SALAMANCA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:135 MOONLIGHT DR
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-5082
Mailing Address - Country:US
Mailing Address - Phone:408-832-5026
Mailing Address - Fax:
Practice Address - Street 1:110 IOWA LN STE 204
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-2400
Practice Address - Country:US
Practice Address - Phone:919-587-8018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19746101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional