Provider Demographics
NPI:1194167890
Name:CAMPBELL, GREGORY LANCE (BS, QP)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:LANCE
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:BS, QP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1990 ALLEN RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-0058
Mailing Address - Country:US
Mailing Address - Phone:252-756-1005
Mailing Address - Fax:252-756-1085
Practice Address - Street 1:1990 ALLEN RD
Practice Address - Street 2:SUITE F
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-0058
Practice Address - Country:US
Practice Address - Phone:252-756-1005
Practice Address - Fax:252-756-1085
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health