Provider Demographics
NPI:1487157566
Name:CAMPBELL, MARIE ELAINE (LMHCA, NCC)
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:ELAINE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LMHCA, NCC
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:ELAINE
Other - Last Name:FITZWATER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9330 59TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-2858
Mailing Address - Country:US
Mailing Address - Phone:253-620-5015
Mailing Address - Fax:253-620-5831
Practice Address - Street 1:9330 59TH AVE SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2858
Practice Address - Country:US
Practice Address - Phone:253-620-1515
Practice Address - Fax:253-620-5831
Is Sole Proprietor?:No
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60830767101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health