=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477555332
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUDITH P CAMPBELL LPC, LMFT, LSATP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2005
-----------------------------------------------------
Last Update Date | 04/28/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 234 SWEET HILLS DR
-----------------------------------------------------
City | AMHERST
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24521-3284
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-929-0355
-----------------------------------------------------
Fax | 434-929-0357
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 128
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24574-0128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-942-6369
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 0701002485
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------