Provider Demographics
NPI:1124157599
Name:CAMPBELL, RICHARD CHARLES (PHD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:CHARLES
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 HINTON AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4785
Mailing Address - Country:US
Mailing Address - Phone:910-350-0004
Mailing Address - Fax:910-350-1206
Practice Address - Street 1:115 HINTON AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4785
Practice Address - Country:US
Practice Address - Phone:910-350-0004
Practice Address - Fax:910-350-1206
Is Sole Proprietor?:No
Enumeration Date:2007-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1680103TC0700X
SC550103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC61-43265OtherUNITED BEHAVIORAL HEALTH
NC0332JOtherBLUE CROSS BLUE SHIELD
NC6000486Medicaid
NC61-43265OtherUNITED BEHAVIORAL HEALTH