Provider Demographics
NPI:1174388300
Name:FERRARO, CAMPBELL ALEXANDRA (LAC, SWC)
Entity type:Individual
Prefix:
First Name:CAMPBELL
Middle Name:ALEXANDRA
Last Name:FERRARO
Suffix:
Gender:F
Credentials:LAC, SWC
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:CAMPBELL
Other - Last Name:OLDHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:336 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANCOS
Mailing Address - State:CO
Mailing Address - Zip Code:81328-9091
Mailing Address - Country:US
Mailing Address - Phone:720-273-0863
Mailing Address - Fax:
Practice Address - Street 1:104 SOUTH MAIN STREET
Practice Address - Street 2:SUITE 5
Practice Address - City:MANCOS
Practice Address - State:CO
Practice Address - Zip Code:81328
Practice Address - Country:US
Practice Address - Phone:979-382-1446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0002353101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)