Provider Demographics
NPI:1477521920
Name:CAMPBELL, DANIEL F (LCSW)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:F
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10560 MAIN ST STE 411
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-7174
Mailing Address - Country:US
Mailing Address - Phone:703-352-3812
Mailing Address - Fax:703-281-1652
Practice Address - Street 1:10560 MAIN ST STE 411
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7174
Practice Address - Country:US
Practice Address - Phone:703-352-3812
Practice Address - Fax:703-281-1652
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040033491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCS960 0001OtherBLUECROSS BLUESHIELD
VA284351OtherBLUECROSS BLUESHIELD