Provider Demographics
NPI:1104387554
Name:CAMPBELL, VIRGINIA E (LMFT)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:E
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6421 BRISA DEL MAR DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-7318
Mailing Address - Country:US
Mailing Address - Phone:808-397-7747
Mailing Address - Fax:
Practice Address - Street 1:6421 BRISA DEL MAR DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-7318
Practice Address - Country:US
Practice Address - Phone:719-602-1924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2022-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFT.0001554106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist