Provider Demographics
NPI:1114407855
Name:CAMPBELL, GABRIELLE NICOLE (RBT)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:NICOLE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 HARDIN RD STE 150
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3507
Mailing Address - Country:US
Mailing Address - Phone:501-603-2147
Mailing Address - Fax:501-603-0324
Practice Address - Street 1:400 HARDIN RD STE 150
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3507
Practice Address - Country:US
Practice Address - Phone:501-603-2147
Practice Address - Fax:501-603-0324
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician