Healthcare Provider Details

I. General information

NPI: 1336656131
Provider Name (Legal Business Name): DENA CAMPBELL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2018
Last Update Date: 12/29/2024
Certification Date: 12/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 SUNNYBROOK RD
RIDGELAND MS
39157-2206
US

IV. Provider business mailing address

241 SUNNYBROOK RD
RIDGELAND MS
39157-2206
US

V. Phone/Fax

Practice location:
  • Phone: 769-231-9414
  • Fax:
Mailing address:
  • Phone: 769-231-9414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2049
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: