Provider Demographics
NPI:1295843902
Name:CAMPBELL, YVONNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:YVONNE
Middle Name:
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 1:4191 INNSLAKE DR STE 211
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-3324
Mailing Address - Country:US
Mailing Address - Phone:804-303-9622
Mailing Address - Fax:047-164-3188
Practice Address - Street 1:4191 INNSLAKE DR STE 211
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-3324
Practice Address - Country:US
Practice Address - Phone:804-303-9622
Practice Address - Fax:804-716-4318
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040026441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8922934Medicaid
VA8922934Medicaid