Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1041C0700X | Clinical Social Worker | 01578 | MD |
Y | 1041C0700X | Clinical Social Worker | LC301829 | DC |
NPI | 1003139536 |
---|---|
Provider Name | Mrs. Pamela Campbell |
First Address | Washington, DC 20012-1324 |
Second Address | Washington, DC 20012-1324 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2010 |
Last Update Date | 23/09/2010 |