Provider Demographics
NPI:1063539476
Name:CAMPBELL, SHEILA J
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:J
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SHEILA
Other - Middle Name:P
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5303 SHIREWICK DR
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-3860
Mailing Address - Country:US
Mailing Address - Phone:678-418-9211
Mailing Address - Fax:678-418-9211
Practice Address - Street 1:5303 SHIREWICK DR
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-3860
Practice Address - Country:US
Practice Address - Phone:678-418-9211
Practice Address - Fax:678-418-9211
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
GA003157101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)