Healthcare Provider Details

I. General information

NPI: 1205777364
Provider Name (Legal Business Name): DWAINE STEVEN CAMPBELL PH.D, L.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2311 E STADIUM BLVD STE 212-5
ANN ARBOR MI
48104-4833
US

IV. Provider business mailing address

2232 S MAIN ST # 136
ANN ARBOR MI
48103-6938
US

V. Phone/Fax

Practice location:
  • Phone: 734-489-1994
  • Fax:
Mailing address:
  • Phone: 734-489-1994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301013123
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: