Individual
DR. SHUSHAN CAMPBELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D., LCP
Contact information
Practice address
10521 ROSEHAVEN ST STE 100, FAIRFAX, VA 22030-2877
(703) 352-3822
Mailing address
10521 ROSEHAVEN ST, SUITE 100, FAIRFAX, VA 22030-2876
(703) 352-3822
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810006451
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1265849822
SOLE PROPRIETOR
VA
Enumeration date
07/16/2014
Last updated
04/08/2020
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