Provider Demographics
NPI:1679384523
Name:CAMPBELL, CHARLA DANIELLE (CDCA, CPRS)
Entity type:Individual
Prefix:
First Name:CHARLA
Middle Name:DANIELLE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:CDCA, CPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 VINE ST
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-2642
Mailing Address - Country:US
Mailing Address - Phone:740-307-0740
Mailing Address - Fax:
Practice Address - Street 1:315 VINE ST
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-2642
Practice Address - Country:US
Practice Address - Phone:740-307-0740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-18
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.005723175T00000X
OHCDCA.190379101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist