Provider Demographics
NPI:1366104572
Name:CAMPBELL, ASHLEY L (LMFTA)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:L
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 ASHPOLE TRL
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-1773
Mailing Address - Country:US
Mailing Address - Phone:252-363-2214
Mailing Address - Fax:
Practice Address - Street 1:5700 SIX FORKS RD STE 202
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-8616
Practice Address - Country:US
Practice Address - Phone:919-961-0334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12327A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist