Provider Demographics
NPI:1730830316
Name:CAMPBELL, DONALD IV (PSYD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:
Last Name:CAMPBELL
Suffix:IV
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 N BRISTOL STREET,
Mailing Address - Street 2:SUITE C, #476
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-3343
Mailing Address - Country:US
Mailing Address - Phone:657-333-2725
Mailing Address - Fax:
Practice Address - Street 1:2017 N OLIVE ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-3512
Practice Address - Country:US
Practice Address - Phone:657-333-2725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY33048103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral