Provider Demographics
NPI:1730640418
Name:SAMUELS CAMPBELL, CHERYL (EDD)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:
Last Name:SAMUELS CAMPBELL
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12501 PROSPERITY DR STE 235
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1650
Mailing Address - Country:US
Mailing Address - Phone:434-533-5901
Mailing Address - Fax:
Practice Address - Street 1:12501 PROSPERITY DR STE 235
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-1650
Practice Address - Country:US
Practice Address - Phone:434-533-5901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4695101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health