Healthcare Provider Details

I. General information

NPI: 1801622287
Provider Name (Legal Business Name): SOPHIA MARIE CAMPBELL LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SOPHIA MARIE ISON

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 SUMMIT AVE
GREENSBORO NC
27405-4522
US

IV. Provider business mailing address

2500 SUMMIT AVE
GREENSBORO NC
27405-4522
US

V. Phone/Fax

Practice location:
  • Phone: 336-621-2500
  • Fax: 336-621-4516
Mailing address:
  • Phone: 336-621-2500
  • Fax: 336-621-4516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP02068
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: