Provider Demographics
NPI:1336237627
Name:CAMPBELL, DOUGLAS VAIL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:VAIL
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9365 AYSCOUGH RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8676
Mailing Address - Country:US
Mailing Address - Phone:843-963-6852
Mailing Address - Fax:843-963-2162
Practice Address - Street 1:437MDOS/LSSC - 204 WEST HILL BLVD
Practice Address - Street 2:
Practice Address - City:CHARLESTON AFB
Practice Address - State:SC
Practice Address - Zip Code:29404
Practice Address - Country:US
Practice Address - Phone:843-963-6852
Practice Address - Fax:843-963-2162
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1312103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical