Provider Demographics
NPI:1548392087
Name:CAMPBELL, VIRGNINA BRIDGFORTH (LPC, ATR-BC)
Entity Type:Individual
Prefix:
First Name:VIRGNINA
Middle Name:BRIDGFORTH
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LPC, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 MILLER ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-4440
Mailing Address - Country:US
Mailing Address - Phone:336-995-5746
Mailing Address - Fax:
Practice Address - Street 1:1035 MILLER ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4440
Practice Address - Country:US
Practice Address - Phone:336-995-5746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5076101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health