Provider Demographics
NPI:1053952424
Name:CAMPBELL, CHELSEA (QMHS, CDCA)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:QMHS, CDCA
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CDCA, QMHS
Mailing Address - Street 1:5439 BURKHARDT RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45431-2111
Mailing Address - Country:US
Mailing Address - Phone:740-400-0411
Mailing Address - Fax:
Practice Address - Street 1:111 UHRIG ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-1427
Practice Address - Country:US
Practice Address - Phone:740-400-0411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-07
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA174758101YA0400X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)