Healthcare Provider Details

I. General information

NPI: 1114595949
Provider Name (Legal Business Name): MELISSA DAWN CAMPBELL CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2021
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239A OLD NATIONAL RD
OLD WASHINGTON OH
43768-5000
US

IV. Provider business mailing address

239A OLD NATIONAL RD
OLD WASHINGTON OH
43768-5000
US

V. Phone/Fax

Practice location:
  • Phone: 740-489-5571
  • Fax:
Mailing address:
  • Phone: 740-489-5571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2613918
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: