Healthcare Provider Details

I. General information

NPI: 1144124389
Provider Name (Legal Business Name): KATHLEEN CAMPBELL LMSW
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 PRINCE AVE STE 13
ATHENS GA
30606-5906
US

IV. Provider business mailing address

740 PRINCE AVE STE 13
ATHENS GA
30606-5906
US

V. Phone/Fax

Practice location:
  • Phone: 706-204-9274
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: