| Doctor Name: | KIMBERLIE CAMPBELL-GLASCO |
| NPI Number: | 1598883829 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 6401008053 |
| Business Practice Address: | 2633 S Lapeer Rd Orion, MI - 483602810 |
| Business Phone Number: | 2483935555 |
| Business Fax Number: | |
| Mailing Address: | 1169 Quail Ridge Dr, OXFORD |
| State: | MI |
| Postal Code: | 483716075 |
| Phone Number: | 2489694977 |
| Fax Number: | |
| NPI Enumeration Date: | 03/26/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 6401008053 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |