Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor | 956497 | FL |
NPI | 1164799557 |
---|---|
Provider Name | Mr. Greggory Fitzgerald Campbell SR. |
First Address | Hialeah, FL 33015-5876 |
Second Address | Oakland Park, FL 33311-1424 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2011 |
Last Update Date | 29/11/2011 |