Healthcare Provider Details

I. General information

NPI: 1871187716
Provider Name (Legal Business Name): CIARA DOMINIQUE CAMPBELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2021
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 PENNSYLVANIA AVE SE SUITE 201
WASHINGTON DC
20003
US

IV. Provider business mailing address

4206 E CAPITOL ST NE APT 20
WASHINGTON DC
20019-4470
US

V. Phone/Fax

Practice location:
  • Phone: 202-546-1512
  • Fax:
Mailing address:
  • Phone: 202-674-3313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: