Provider Demographics
NPI:1699418566
Name:CAMPBELL, KOREY (LISW)
Entity type:Individual
Prefix:
First Name:KOREY
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 GAMBIER CIR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45218-1427
Mailing Address - Country:US
Mailing Address - Phone:810-841-2480
Mailing Address - Fax:
Practice Address - Street 1:22 CENTURY BLVD STE 220
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-3787
Practice Address - Country:US
Practice Address - Phone:513-818-4947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.20020491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical