Healthcare Provider Details

I. General information

NPI: 1710234059
Provider Name (Legal Business Name): JANET MARIE CAMPBELL LCSWA, LCAS-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2012
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22421 ANDREW JACKSON HWY
MAXTON NC
28364-6721
US

IV. Provider business mailing address

P.O. BOX 243 HWY 71 S 8236
RED SPRINGS NC
28377-0243
US

V. Phone/Fax

Practice location:
  • Phone: 910-844-2008
  • Fax:
Mailing address:
  • Phone: 910-316-8807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP006913
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-25582
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: