Provider Demographics
NPI:1053144881
Name:CAMPBELL, SANAIA D
Entity type:Individual
Prefix:
First Name:SANAIA
Middle Name:D
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 TECH BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-7863
Mailing Address - Country:US
Mailing Address - Phone:813-438-6796
Mailing Address - Fax:
Practice Address - Street 1:6100 VETERANS PKWY STE 11
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-3514
Practice Address - Country:US
Practice Address - Phone:706-221-8966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician