Healthcare Provider Details

I. General information

NPI: 1619562485
Provider Name (Legal Business Name): CHRISTINE LEE AUSTIN CAMPBELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 03/04/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 SHATTUCK WAY STE 1
NEWINGTON NH
03801-7860
US

IV. Provider business mailing address

177 SHATTUCK WAY
NEWINGTON NH
03801-7879
US

V. Phone/Fax

Practice location:
  • Phone: 603-436-0448
  • Fax:
Mailing address:
  • Phone: 603-436-0448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: