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General NPI Number Information
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NPI Number | 1093991069
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Entity Type | Individual
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Provider Name | LAQUANITA SHANEL CAMPBELL
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Gender | Female
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Dates
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Enumeration Date | 01/21/2008
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Last Update Date | 07/26/2012
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Provider Practice Location Address
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Address Line | 6814 STABLETON LN
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City | HOUSTON
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State | TX
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Zip | 77049-2054
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Country | US
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Telephone | 713-548-7438
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Fax |
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Provider Business Mailing Address
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Address Line | 6814 STABLETON LN
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City | HOUSTON
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State | TX
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Zip | 77049-2054
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Country | US
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Telephone | 713-548-7438
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number |
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Taxonomy #4
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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Taxonomy #5
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 210151
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License Number State | TX
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