Provider Demographics
NPI:1639928377
Name:CAMPBELL, KAILEY (MA, LPCA)
Entity type:Individual
Prefix:MRS
First Name:KAILEY
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MA, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 VALLEY HEIGHTS LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-5862
Mailing Address - Country:US
Mailing Address - Phone:508-649-1581
Mailing Address - Fax:
Practice Address - Street 1:337 VALLEY HEIGHTS LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-5862
Practice Address - Country:US
Practice Address - Phone:508-649-1581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8775101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty