Provider Demographics
NPI:1033552641
Name:CAMPANELLA, PERRY (LPC)
Entity Type:Individual
Prefix:MR
First Name:PERRY
Middle Name:
Last Name:CAMPANELLA
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2219 COWAN BLVD
Mailing Address - Street 2:APT 50-C
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4442
Mailing Address - Country:US
Mailing Address - Phone:804-218-4124
Mailing Address - Fax:
Practice Address - Street 1:2219 COWAN BLVD
Practice Address - Street 2:APT 50-C
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4442
Practice Address - Country:US
Practice Address - Phone:804-218-4124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003801101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health