Healthcare Provider Details

I. General information

NPI: 1891317962
Provider Name (Legal Business Name): MOLLY R BAATZ BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2020
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2329 E WT HARRIS BLVD
CHARLOTTE NC
28213-5186
US

IV. Provider business mailing address

10877 OVERSEAS HWY APT 11
MARATHON FL
33050-3432
US

V. Phone/Fax

Practice location:
  • Phone: 704-529-9090
  • Fax: 704-529-9009
Mailing address:
  • Phone: 614-361-2013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-56687
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: