| Doctor Name: | JEREMY TODD CAMPBELL |
| NPI Number: | 1053742544 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 826 Deleware Ave Fountain Hill, PA - 18015 |
| Business Phone Number: | 6104193101 |
| Business Fax Number: | 6104193309 |
| Mailing Address: | 219 Main St, METUCHEN |
| State: | NJ |
| Postal Code: | 088402727 |
| Phone Number: | 7328872540 |
| Fax Number: | 6104193309 |
| NPI Enumeration Date: | 12/09/2013 |
| NPI Last Update Date: | 12/09/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP1600X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Pastoral |
| Taxonomy Definition: | |