MEDICARE: DARYL CAMPBELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	CAP10007	FL
2	101YM0800X	Mental Health Counselor	17770	FL

General Provider Information

NPI Number	:	1548727993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARYL CAMPBELL

Provider Business Mailing Address
First Line	:	426 SW 27TH AVE APT 307
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33312-2199
Country	:	US
Telephone Number	:	954-218-4522
Fax Number	:

Provider Business Practice Location Address
First Line	:	426 SW 27TH AVE APT 307
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33312-2199
Country	:	US
Telephone Number	:	954-218-4522
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2019
Last Update Date	:	11/07/2022

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Directions to “ DARYL CAMPBELL ” Practice Location

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