Individual
MR. WILLIE CAMPBELL JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS TLLP
Contact information
Practice address
5575 CONNER ST, DETROIT, MI 48213-6400
(313) 643-5542
(248) 522-7045
Mailing address
21575 DUNS SCOTUS ST, SOUTHFIELD, MI 48075-3226
(313) 595-9039
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301016973
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6301016973
—
MI
Enumeration date
11/27/2017
Last updated
11/27/2017
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