MEDICARE: RONALD CAMPBELL JR. LCMHC

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	23776	NC
2	101YM0800X	Mental Health Counselor	11368	NC

General Provider Information

NPI Number	:	1538400254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD CAMPBELL JR. LCMHC

Provider Business Mailing Address
First Line	:	1229 SHENANDOAH CIR
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29730-3664
Country	:	US
Telephone Number	:	843-908-1261
Fax Number	:

Provider Business Practice Location Address
First Line	:	2315 E WT HARRIS BLVD STE 102
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28213-5133
Country	:	US
Telephone Number	:	704-208-4458
Fax Number	:	866-309-6385

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

Provider Enumeration Date	:	03/05/2013
Last Update Date	:	12/18/2024

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