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NPI Code Detail

MEDICARE: DR. AMANDA L CAMPBELL PH.D.

MEDICARE: DR. AMANDA L CAMPBELL PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist0810007199VA

General Provider Information

NPI Number : 1760095038
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AMANDA L CAMPBELL PH.D.
Provider Business Mailing Address
First Line : 4337 COX RD
Second Line :
City : GLEN ALLEN
State : VA
Zip : 23060-3359
Country : US
Telephone Number : 804-277-9877
Fax Number :
Provider Business Practice Location Address
First Line : 4337 COX RD
Second Line :
City : GLEN ALLEN
State : VA
Zip : 23060-3359
Country : US
Telephone Number : 804-277-9877
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2020
Last Update Date : 08/26/2020

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