Provider Demographics
NPI:1407950512
Name:SALEHI, KAMPBELL (PSYD)
Entity type:Individual
Prefix:DR
First Name:KAMPBELL
Middle Name:
Last Name:SALEHI
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8134 OLD KEENE MILL RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-1800
Mailing Address - Country:US
Mailing Address - Phone:703-569-8731
Mailing Address - Fax:703-569-7248
Practice Address - Street 1:8134 OLD KEENE MILL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1800
Practice Address - Country:US
Practice Address - Phone:703-569-8731
Practice Address - Fax:703-569-7248
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1037C0700X103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010092736Medicaid