Provider Demographics
NPI:1952790388
Name:CAMPBELL-JOHANNES, CARLYN REBECCA (MA, LPC)
Entity Type:Individual
Prefix:
First Name:CARLYN
Middle Name:REBECCA
Last Name:CAMPBELL-JOHANNES
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:CARLYN
Other - Middle Name:REBECCA
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3454 OAK ALLEY CT
Mailing Address - Street 2:SUITE 406
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1306
Mailing Address - Country:US
Mailing Address - Phone:567-343-5645
Mailing Address - Fax:
Practice Address - Street 1:3454 OAK ALLEY CT
Practice Address - Street 2:SUITE 406
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1306
Practice Address - Country:US
Practice Address - Phone:419-742-2745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-22
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1400528101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional