Provider Demographics
NPI:1548809148
Name:CAMPBELL, CHERYL DENISE
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:DENISE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 GRANDE VIEW TRACE
Mailing Address - Street 2:
Mailing Address - City:MAYLEANE
Mailing Address - State:AL
Mailing Address - Zip Code:35114
Mailing Address - Country:US
Mailing Address - Phone:205-515-6934
Mailing Address - Fax:
Practice Address - Street 1:404 15TH ST N
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35203-1845
Practice Address - Country:US
Practice Address - Phone:205-777-4022
Practice Address - Fax:205-777-4023
Is Sole Proprietor?:No
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor