Healthcare Provider Details

I. General information

NPI: 1629907100
Provider Name (Legal Business Name): LAUREN SUSAN CAMPBELL LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 PROFESSIONAL CIR STE 102
COLTS NECK NJ
07722-2429
US

IV. Provider business mailing address

5 PROFESSIONAL CIR STE 102
COLTS NECK NJ
07722-2429
US

V. Phone/Fax

Practice location:
  • Phone: 732-200-2891
  • Fax:
Mailing address:
  • Phone: 732-200-2891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00954900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: