Provider Demographics
NPI:1457055857
Name:CAMPBELL, GRACE E (LMFTA)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:E
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 1:150 E FIRE TOWER RD
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-8378
Mailing Address - Country:US
Mailing Address - Phone:434-546-2214
Mailing Address - Fax:
Practice Address - Street 1:140 SCHOOL DR
Practice Address - Street 2:
Practice Address - City:SNOW HILL
Practice Address - State:NC
Practice Address - Zip Code:28580-7288
Practice Address - Country:US
Practice Address - Phone:252-747-8162
Practice Address - Fax:252-747-8163
Is Sole Proprietor?:No
Enumeration Date:2023-03-29
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10298A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist