Provider Demographics
NPI:1477555332
Name:CAMPBELL, JUDITH P (LPC, LMFT, LSATP)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:P
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LPC, LMFT, LSATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:VA
Mailing Address - Zip Code:24574-0128
Mailing Address - Country:US
Mailing Address - Phone:434-942-6369
Mailing Address - Fax:
Practice Address - Street 1:234 SWEET HILLS DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:VA
Practice Address - Zip Code:24521-3284
Practice Address - Country:US
Practice Address - Phone:434-929-0355
Practice Address - Fax:434-929-0357
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002485101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010221030Medicaid
186483OtherANTHEM PROVIDER NUMBER
20-3639329OtherPCHP PROVIDER NUMBER
86528MOtherSENTARA/OPTIMA PROVIDER N
2129118OtherCIGNA BEHAVIOR PROVIDER N
203639329001OtherTRICARE PROVIDER NUMBER
464154OtherVALUE OPTIONS PROVIDER NU