Provider Demographics
NPI:1053597773
Name:CAMPBELL, GEORGE (CADC)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11191 ILLINOIS ROUTE 185
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62049-2664
Mailing Address - Country:US
Mailing Address - Phone:217-532-2001
Mailing Address - Fax:217-532-6361
Practice Address - Street 1:11191 ILLINOIS ROUTE 185
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:IL
Practice Address - Zip Code:62049-2664
Practice Address - Country:US
Practice Address - Phone:217-532-2001
Practice Address - Fax:217-532-6361
Is Sole Proprietor?:No
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
IL6189101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor