Provider Demographics
NPI:1598819559
Name:CAMPBELL, JEAN CHRISTINE (LICSW)
Entity type:Individual
Prefix:MS
First Name:JEAN
Middle Name:CHRISTINE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 107
Mailing Address - Street 2:
Mailing Address - City:GARRETT PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20896-0107
Mailing Address - Country:US
Mailing Address - Phone:202-271-1301
Mailing Address - Fax:
Practice Address - Street 1:5028 WISCONSIN AVE NW STE 400
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4118
Practice Address - Country:US
Practice Address - Phone:202-271-1301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD127321041C0700X
DCLC500778871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical