Provider Demographics
NPI:1508032160
Name:CAMPBELL, SARA LOUISE (LPC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:LOUISE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2758 E MILLENNIUM DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4798
Mailing Address - Country:US
Mailing Address - Phone:479-430-2323
Mailing Address - Fax:479-269-4977
Practice Address - Street 1:2758 E MILLENNIUM DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4798
Practice Address - Country:US
Practice Address - Phone:479-430-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ARP1709351101YP2500X
ARA1505071101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP1709351OtherSTATE LICENSE
AR227774719Medicaid