Provider Demographics
NPI:1891966602
Name:CAMPBELL, VICTORIA A (LMFT)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:A
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 W WALNUT ST # MB4
Mailing Address - Street 2:
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-2460
Mailing Address - Country:US
Mailing Address - Phone:831-588-7631
Mailing Address - Fax:
Practice Address - Street 1:4601 W WALNUT ST # MB4
Practice Address - Street 2:
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2460
Practice Address - Country:US
Practice Address - Phone:831-588-7631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-19
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1472106H00000X
CA47586106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist