Provider Demographics
NPI:1487786885
Name:CAMPBELL, CHRISTINE NONE (LP)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:NONE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:NONE
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LP
Mailing Address - Street 1:1505 BRIDGEWAY
Mailing Address - Street 2:SUITE 112
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965-1966
Mailing Address - Country:US
Mailing Address - Phone:415-331-8064
Mailing Address - Fax:415-331-8064
Practice Address - Street 1:1505 BRIDGEWAY
Practice Address - Street 2:SUITE 112
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-1966
Practice Address - Country:US
Practice Address - Phone:415-331-8064
Practice Address - Fax:415-331-8064
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12882101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA97295OtherBLUE SHIELD OF CALIFORNIA