MEDICARE: VICTORIA CAMPBELL CADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	37CA00199400	NJ

General Provider Information

NPI Number	:	1508739921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA CAMPBELL CADC

Provider Business Mailing Address
First Line	:	69 BROAD ST
Second Line	:
City	:	RED BANK
State	:	NJ
Zip	:	07701-1946
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	69 BROAD ST
Second Line	:
City	:	RED BANK
State	:	NJ
Zip	:	07701-1946
Country	:	US
Telephone Number	:	201-241-3598
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2025
Last Update Date	:	09/24/2025

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