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General NPI Number Information
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NPI Number | 1144008582
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Entity Type | Individual
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Provider Name | LACEY DANIELLE CAMPBELL LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/18/2023
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 3205 FREEDOM DR STE 2000
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City | CHARLOTTE
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State | NC
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Zip | 28208-3486
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Country | US
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Telephone | 980-257-4811
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Fax |
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Provider Business Mailing Address
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Address Line | 2643 MCCURDY TRL
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City | CHARLOTTE
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State | NC
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Zip | 28269-4553
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Country | US
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Telephone | 704-352-3469
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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 | C017628
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License Number State | NC
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