Healthcare Provider Details

I. General information

NPI: 1063897429
Provider Name (Legal Business Name): ALEXIS JAIXEN CAMPBELL LCSW LCAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2015
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: 828-631-3973
  • Fax: 828-631-9280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC011512
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: