Provider Demographics
NPI:1437546090
Name:CAMPBELL, VENESHIA
Entity Type:Individual
Prefix:
First Name:VENESHIA
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 E PRINCETON ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1435
Mailing Address - Country:US
Mailing Address - Phone:407-303-8877
Mailing Address - Fax:407-303-8811
Practice Address - Street 1:615 E PRINCETON ST STE 101
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1435
Practice Address - Country:US
Practice Address - Phone:407-303-8877
Practice Address - Fax:407-303-8811
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-22
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health