Provider Demographics
NPI:1447506878
Name:CAMPBELL, PAMELA MARIE (MFT INTERN)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:MARIE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 ST. MARK'S PLAZA #5
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207
Mailing Address - Country:US
Mailing Address - Phone:209-470-2946
Mailing Address - Fax:209-955-1050
Practice Address - Street 1:1545 ST. MARK'S PLAZA #5
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207
Practice Address - Country:US
Practice Address - Phone:209-470-2946
Practice Address - Fax:209-955-1050
Is Sole Proprietor?:No
Enumeration Date:2012-08-03
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66111106H00000X
CA85859106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist