Provider Demographics
NPI:1164219911
Name:CAMPBELL, JESSICA ANNE (RIMHC)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ANNE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:RIMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10928 SW 189TH TER
Mailing Address - Street 2:
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34432-4538
Mailing Address - Country:US
Mailing Address - Phone:631-522-6262
Mailing Address - Fax:
Practice Address - Street 1:2440 N ESSEX AVE
Practice Address - Street 2:
Practice Address - City:CITRUS HILLS
Practice Address - State:FL
Practice Address - Zip Code:34442-5320
Practice Address - Country:US
Practice Address - Phone:352-558-8054
Practice Address - Fax:352-218-8485
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH26592101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty