Provider Demographics
NPI:1053970244
Name:CAMPBELL, CRISTIN E
Entity type:Individual
Prefix:MRS
First Name:CRISTIN
Middle Name:E
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CRISTIN
Other - Middle Name:E
Other - Last Name:MESSER/HEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26001 REDLANDS BLVD
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-7762
Mailing Address - Country:US
Mailing Address - Phone:909-894-7572
Mailing Address - Fax:
Practice Address - Street 1:26001 REDLANDS BLVD
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-7762
Practice Address - Country:US
Practice Address - Phone:909-894-7572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12983104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker