Provider Demographics
NPI:1447122213
Name:SIMON-CAMPBELL, HAVEN
Entity type:Individual
Prefix:MISS
First Name:HAVEN
Middle Name:
Last Name:SIMON-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 1:1190 LYNNHAVEN PKWY
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-4814
Mailing Address - Country:US
Mailing Address - Phone:757-468-5444
Mailing Address - Fax:757-468-2091
Practice Address - Street 1:1190 LYNNHAVEN PKWY
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-4814
Practice Address - Country:US
Practice Address - Phone:757-468-5444
Practice Address - Fax:757-468-2091
Is Sole Proprietor?:No
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019019523225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist