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General NPI Number Information
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NPI Number | 1104912963
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Entity Type | Individual
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Provider Name | ANDREA SUE CAMPBELL LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 05/22/2023
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Provider Practice Location Address
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Address Line | 429 N PENNSYLVANIA ST STE 111
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City | INDIANAPOLIS
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State | IN
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Zip | 46204-1873
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Country | US
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Telephone | 855-284-7483
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 748465
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City | ATLANTA
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State | GA
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Zip | 30374-8465
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Country | US
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Telephone | 855-284-7483
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 16894
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 105921
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 124132
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW18247
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I.2103027
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License Number State | OH
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Taxonomy #6
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34004864A
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License Number State | IN
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