Healthcare Provider Details

I. General information

NPI: 1154297307
Provider Name (Legal Business Name): ALEXIS CAMPBELL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2025
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 WEST 1ST ST N SUITE B
MORRISTOWN TN
37814-4534
US

IV. Provider business mailing address

5549 CARLYLE AVE
RUSSELLVILLE TN
37860-9368
US

V. Phone/Fax

Practice location:
  • Phone: 828-222-6330
  • Fax:
Mailing address:
  • Phone: 828-222-6330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ALEXIS JAIXEN CAMPBELL
Title or Position: OWNER
Credential: LCSW LCAS
Phone: 336-813-0977