Provider Demographics
NPI:1902625940
Name:CAMPBELL, BRENDA (LICSW)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
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 1:316 HANNES ST
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-1103
Mailing Address - Country:US
Mailing Address - Phone:202-641-5252
Mailing Address - Fax:
Practice Address - Street 1:3400 MARTIN LUTHER KING JR AVE SE STE 300
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-1542
Practice Address - Country:US
Practice Address - Phone:202-724-7666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLCL303359101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health