Provider Demographics
NPI:1013168806
Name:CAMPBELL, VALERIE GRAHAM (MS)
Entity Type:Individual
Prefix:PROF
First Name:VALERIE
Middle Name:GRAHAM
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 E LAKE ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-4515
Mailing Address - Country:US
Mailing Address - Phone:407-931-3199
Mailing Address - Fax:407-931-3199
Practice Address - Street 1:303 E LAKE ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-4515
Practice Address - Country:US
Practice Address - Phone:407-931-3199
Practice Address - Fax:407-931-3199
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 6808101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH #6808OtherSTATE OF FLORIDA DEPT OF HEALTH - DIVISION OF MEDICAL QUALITY ASSURANCE