Provider Demographics
NPI:1265030415
Name:CAMPBELL, VICTORIA (LPC)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 ELLINGTON PL
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-5154
Mailing Address - Country:US
Mailing Address - Phone:615-293-9565
Mailing Address - Fax:
Practice Address - Street 1:8283 RIVER ROAD PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-6018
Practice Address - Country:US
Practice Address - Phone:615-432-3107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-10
Last Update Date:2020-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5187101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional