Provider Demographics
NPI:1952196529
Name:CAMPBELL, DERRICK
Entity type:Individual
Prefix:
First Name:DERRICK
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 757
Mailing Address - Street 2:
Mailing Address - City:GUYTON
Mailing Address - State:GA
Mailing Address - Zip Code:31312-0757
Mailing Address - Country:US
Mailing Address - Phone:912-297-6539
Mailing Address - Fax:912-500-2970
Practice Address - Street 1:5717 GA HIGHWAY 21 S
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-5554
Practice Address - Country:US
Practice Address - Phone:912-297-6539
Practice Address - Fax:912-500-2970
Is Sole Proprietor?:No
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor