Healthcare Provider Details

I. General information

NPI: 1861859332
Provider Name (Legal Business Name): TERRIE CAMPBELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2016
Last Update Date: 01/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 MCCLELLAN AVE SUITE 300
PENNSAUKEN NJ
08109-4613
US

IV. Provider business mailing address

2500 MCCLELLAN AVENUE SUITE 300
PENNSAUKEN NJ
08109
US

V. Phone/Fax

Practice location:
  • Phone: 856-361-1100
  • Fax:
Mailing address:
  • Phone: 856-361-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: