Mary Lynn Campbell, LCAS 30162

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

30162 Issued in NC

Practice address

1532 Vandenberg Dr
Fayetteville, NC 28312-7639

Phone

(472) 208-7904

NPI assigned

May 25, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Forged by Fire Counseling Services, LLC

  • Addiction (Substance Use Disorder) Counselor
  • Fayetteville, NC
  • NPI 1609691757
  NPD Authorized official
• Mayrx

  • Family Medicine Physician
  • Asheville, NC
  • NPI 1255039897
  NPD
• Mayrx Recovery

  • Community/Behavioral Health Agency
  • Asheville, NC
  • NPI 1154186013
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1621900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734998400000",
    "number": "1205401833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1532 VANDENBERG DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283127639",
            "telephone_number": "472-208-7904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1532 VANDENBERG DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283127639",
            "telephone_number": "472-208-7904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMPBELL",
        "first_name": "MARY",
        "middle_name": "LYNN",
        "credential": "LCAS 30162",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-05-25",
        "last_updated": "2024-12-24",
        "certification_date": "2024-12-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "30162",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Camisha Michele Campbell
• Erica Campbell, PHD, MSW, LCSWA
• Jelicia Da'Chelle Campbell
• Kristleena Campbell
• Lisa Campbell, CADC
• Shamika Sallie Campbell, QASP-S
• Theadora Devone Campbell, PA-C
• Theresa J. Campbell, FNP
• Vaneka Campbell
• Lea Campo, RBT

• Addiction (Substance Use Disorder) Counselor in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Addiction (Substance Use Disorder) Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.