Provider Demographics
NPI:1932121290
Name:CAMPBELL, GAIL W (LPC, LSATP)
Entity Type:Individual
Prefix:MS
First Name:GAIL
Middle Name:W
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LPC, LSATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10390 DEMOCRACY LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2522
Mailing Address - Country:US
Mailing Address - Phone:703-219-2560
Mailing Address - Fax:703-591-5755
Practice Address - Street 1:10390 DEMOCRACY LN
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2522
Practice Address - Country:US
Practice Address - Phone:703-219-2560
Practice Address - Fax:703-591-5755
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003532101YA0400X
VA0718000175101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)