Provider Demographics
NPI:1952424889
Name:CAMPBELL, DAVID R (LISAC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 S POWER RD
Mailing Address - Street 2:114
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-5235
Mailing Address - Country:US
Mailing Address - Phone:480-981-1022
Mailing Address - Fax:480-981-1405
Practice Address - Street 1:215 S POWER RD
Practice Address - Street 2:114
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-5235
Practice Address - Country:US
Practice Address - Phone:480-981-1022
Practice Address - Fax:480-981-1405
Is Sole Proprietor?:No
Enumeration Date:2007-04-07
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC11711101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ942335Medicaid