Basic Information
| Provider Information | |||||||||
| NPI: | 1881854321 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAMPBELL | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LICSW, SUDP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1845 | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986681845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603978488 | ||||||||
| FaxNumber: | 3603978492 | ||||||||
| Practice Location | |||||||||
| Address1: | 1601 E FOURTH PLAIN BLVD | ||||||||
| Address2: | BLDG 17, STE B222 | ||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986613753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606397848 | ||||||||
| FaxNumber: | 3603978492 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2008 | ||||||||
| LastUpdateDate: | 01/13/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | CP60131564 | WA | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | LW60987256 | WA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.