Provider Demographics
NPI:1093754509
Name:CAMPBELL, CELESTE ANNE (PSY D)
Entity type:Individual
Prefix:DR
First Name:CELESTE
Middle Name:ANNE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3396 SHADY HOLLOW RUN
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-4252
Mailing Address - Country:US
Mailing Address - Phone:703-867-6016
Mailing Address - Fax:
Practice Address - Street 1:2295 PARKLAKE DR NE STE 551
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-2951
Practice Address - Country:US
Practice Address - Phone:703-867-6016
Practice Address - Fax:470-231-1080
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001978103G00000X, 103T00000X
GAPSY003853103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7700873Medicaid
017910SC34Medicare ID - Type Unspecified
522131Medicare UPIN