Provider Demographics
NPI:1942216544
Name:CAMPBELL, NANCY J (LISW)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 WOFFORD DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-0501
Mailing Address - Country:US
Mailing Address - Phone:505-642-4276
Mailing Address - Fax:505-522-3689
Practice Address - Street 1:500 SOUTH MAIN ST
Practice Address - Street 2:SUITE 430
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-2959
Practice Address - Country:US
Practice Address - Phone:505-532-9050
Practice Address - Fax:505-522-3689
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-38641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical