Healthcare Provider Details

I. General information

NPI: 1609200906
Provider Name (Legal Business Name): KATHARINE CAMPBELL COUNSELING & CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2013
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1881 NE 26TH ST SUITE 70
WILTON MANORS FL
33305-1416
US

IV. Provider business mailing address

PO BOX 11
CONNELLY SPRINGS NC
28612-0011
US

V. Phone/Fax

Practice location:
  • Phone: 954-507-0137
  • Fax: 954-990-4480
Mailing address:
  • Phone: 954-507-0137
  • Fax: 954-990-4480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSW8032
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. KATHARINE CAMPBELL
Title or Position: OWNER
Credential: LCSW, PHD
Phone: 954-507-0137