Provider Demographics
NPI:1588344642
Name:CAMPBELL, AMANDA WILMOTH (LCSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:WILMOTH
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-3760
Mailing Address - Country:US
Mailing Address - Phone:143-471-0011
Mailing Address - Fax:
Practice Address - Street 1:324 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-3760
Practice Address - Country:US
Practice Address - Phone:143-471-0011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040156001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical