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General NPI Number Information
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NPI Number | 1750020954
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Entity Type | Organization
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Legal Business Name | CAMPBELL INTEGRATIVE PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 06/03/2022
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Last Update Date | 06/03/2022
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Provider Practice Location Address
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Address Line | 8200 GREENSBORO DR STE 900
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City | MC LEAN
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State | VA
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Zip | 22102-4931
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Country | US
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Telephone | 571-255-9859
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Fax |
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Provider Business Mailing Address
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Address Line | 8200 GREENSBORO DR STE 900
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City | MC LEAN
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State | VA
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Zip | 22102-4931
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST/CLINUCAL DIRECTOR
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Name | DR. SHUSHAN CAMPBELL
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Credential |
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Telephone | 571-255-9859
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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