Provider Demographics
NPI:1144810094
Name:CAMPBELL, CHEVELLA JOYNELL (LCDC)
Entity type:Individual
Prefix:MRS
First Name:CHEVELLA
Middle Name:JOYNELL
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 398406
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75339-8406
Mailing Address - Country:US
Mailing Address - Phone:214-613-6999
Mailing Address - Fax:
Practice Address - Street 1:3911 S LANCASTER RD STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-5682
Practice Address - Country:US
Practice Address - Phone:214-613-6999
Practice Address - Fax:214-382-0323
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15596101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)