Individual
JUANITA M CAMPBELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LBSC
Contact information
Practice address
2911 S 67TH ST, PHILADELPHIA, PA 19142-2604
(215) 350-9998
Mailing address
2625 S 80TH ST, PHILADELPHIA, PA 19153-1734
(215) 350-9998
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
BH001975
PA
251S00000X
Community/Behavioral Health Agency
Primary
BH001975
PA
Other
Enumeration date
09/10/2018
Last updated
09/10/2018
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