Provider Demographics
NPI:1912719931
Name:CAMPBELL, KRISTA MARIE (ACSW)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:MARIE
Last Name:CAMPBELL
Suffix:
Gender:
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 TREEMONT PL APT 203
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-7952
Mailing Address - Country:US
Mailing Address - Phone:949-293-1001
Mailing Address - Fax:
Practice Address - Street 1:3769 TIBBETTS ST STE A
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2638
Practice Address - Country:US
Practice Address - Phone:949-293-1001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-27
Last Update Date:2025-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker