Healthcare Provider Details

I. General information

NPI: 1912204025
Provider Name (Legal Business Name): CYNTHIA K CAMPBELL MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CYNTHIA K CAMPBELL WEAVER MSW, LCSW

II. Dates (important events)

Enumeration Date: 02/25/2011
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N COLLEGE AVE
FAYETTEVILLE AR
72703-1944
US

IV. Provider business mailing address

1100 N COLLEGE AVE
FAYETTEVILLE AR
72703-1944
US

V. Phone/Fax

Practice location:
  • Phone: 479-443-4301
  • Fax: 479-587-5994
Mailing address:
  • Phone: 479-443-4301
  • Fax: 479-587-5994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1999141225
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: