Provider Demographics
NPI:1033485909
Name:CAMPBELL, ELIZABETH (MS, LPC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4629 MANSION ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19127-1118
Mailing Address - Country:US
Mailing Address - Phone:610-757-8163
Mailing Address - Fax:
Practice Address - Street 1:302 SOUTH BETHLEHEM PIKE
Practice Address - Street 2:BUILDING B
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002
Practice Address - Country:US
Practice Address - Phone:610-757-8163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006042101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor