Provider Demographics
NPI:1447044680
Name:CAMPBELL, JEREMY (CADC II)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:
Credentials:CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3714 S PARTON ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-4831
Mailing Address - Country:US
Mailing Address - Phone:714-824-9896
Mailing Address - Fax:
Practice Address - Street 1:3714 S PARTON ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-4831
Practice Address - Country:US
Practice Address - Phone:714-824-9896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA064710724101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)