Provider Demographics
NPI:1912080649
Name:CAMPBELL, MARJORIE SAILE (PHD, LCP)
Entity Type:Individual
Prefix:DR
First Name:MARJORIE
Middle Name:SAILE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PHD, LCP
Other - Prefix:DR
Other - First Name:MARJORIE
Other - Middle Name:SAILE
Other - Last Name:FABIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, LCP
Mailing Address - Street 1:100 PINEWOOD RD APT 132
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-3969
Mailing Address - Country:US
Mailing Address - Phone:760-828-8701
Mailing Address - Fax:
Practice Address - Street 1:1206 LASKIN RD STE 201
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-5263
Practice Address - Country:US
Practice Address - Phone:757-428-2192
Practice Address - Fax:757-428-7875
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002445103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA242557OtherANTHEM PROVIDER NUMBER
VAO87441OtherOPTIMA PROVIDER NUMBER
VAP13981Medicare UPIN
VA242557OtherANTHEM PROVIDER NUMBER