Healthcare Provider Details

I. General information

NPI: 1669543377
Provider Name (Legal Business Name): JOHN T CAMPBELL JR. D.MIN.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 W MAIN ST SUITE #8
BREVARD NC
28712-3634
US

IV. Provider business mailing address

PO BOX 206
BREVARD NC
28712-0206
US

V. Phone/Fax

Practice location:
  • Phone: 828-884-7154
  • Fax:
Mailing address:
  • Phone: 828-884-7154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number63
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5276
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number003049
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: