Provider Demographics
NPI:1922805712
Name:CAMPBELL, CHARLES BENTON
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:BENTON
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3637 SETTLERS LN
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-2230
Mailing Address - Country:US
Mailing Address - Phone:205-873-4501
Mailing Address - Fax:
Practice Address - Street 1:2685 PELHAM PKWY STE B
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124-1354
Practice Address - Country:US
Practice Address - Phone:205-210-8259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC04601101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health