Provider Demographics
NPI:1417787649
Name:CAMPBELL, JAIAH INDIRAH
Entity type:Individual
Prefix:
First Name:JAIAH
Middle Name:INDIRAH
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 CYNTHIAS PL APT 101
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22406-7499
Mailing Address - Country:US
Mailing Address - Phone:540-310-3511
Mailing Address - Fax:
Practice Address - Street 1:58 CYNTHIAS PL APT 101
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22406-7499
Practice Address - Country:US
Practice Address - Phone:540-310-3511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician