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General NPI Number Information
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NPI Number | 1598819559
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Entity Type | Individual
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Provider Name | JEAN CHRISTINE CAMPBELL LICSW
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Gender | Female
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 07/24/2019
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Provider Practice Location Address
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Address Line | 5028 WISCONSIN AVE NW STE 400
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City | WASHINGTON
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State | DC
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Zip | 20016-4118
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Country | US
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Telephone | 202-271-1301
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 107
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City | GARRETT PARK
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State | MD
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Zip | 20896-0107
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Country | US
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Telephone | 202-271-1301
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 12732
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC50077887
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License Number State | DC
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