Basic Information
| Provider Information | |||||||||
| NPI: | 1760493597 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAMPBELL | ||||||||
| FirstName: | CATHERINE | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LLMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23933 ALLEN RD | ||||||||
| Address2: | STE 3 | ||||||||
| City: | WOODHAVEN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481833368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342825097 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 23933 ALLEN RD | ||||||||
| Address2: | STE 3 | ||||||||
| City: | WOODHAVEN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481833368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3134504500 | ||||||||
| FaxNumber: | 3134504514 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2006 | ||||||||
| LastUpdateDate: | 07/25/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6801085302 | MI | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.