Provider Demographics
NPI:1568288983
Name:CAMPBELL, KRYSTAL DENISE-LILLIAN
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:DENISE-LILLIAN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 MAPLEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-4027
Mailing Address - Country:US
Mailing Address - Phone:717-666-9161
Mailing Address - Fax:
Practice Address - Street 1:2750 MAPLEWOOD CIR
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-4027
Practice Address - Country:US
Practice Address - Phone:717-666-9161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-02
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health