Provider Demographics
NPI:1295006302
Name:CAMPBELL, AMY LYNNE (LCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LYNNE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23164 DRAGOON RD
Mailing Address - Street 2:
Mailing Address - City:LIGNUM
Mailing Address - State:VA
Mailing Address - Zip Code:22726-2036
Mailing Address - Country:US
Mailing Address - Phone:540-399-1926
Mailing Address - Fax:540-399-1193
Practice Address - Street 1:23164 DRAGOON RD
Practice Address - Street 2:
Practice Address - City:LIGNUM
Practice Address - State:VA
Practice Address - Zip Code:22726-2036
Practice Address - Country:US
Practice Address - Phone:540-399-1926
Practice Address - Fax:540-399-1193
Is Sole Proprietor?:No
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040078281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical