Healthcare Provider Details

I. General information

NPI: 1124729306
Provider Name (Legal Business Name): KEEGAN DANIEL CAMPBELL LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 HIGH ST STE 509
MORGANTOWN WV
26505-5454
US

IV. Provider business mailing address

235 HIGH ST STE 509
MORGANTOWN WV
26505-5454
US

V. Phone/Fax

Practice location:
  • Phone: 304-996-3639
  • Fax:
Mailing address:
  • Phone: 304-996-3639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberDP00945310
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberDP00945310
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: