Healthcare Provider Details

I. General information

NPI: 1083248405
Provider Name (Legal Business Name): MOLLY E CAMPBELL KROLL EDD, BCBA-D, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2020
Last Update Date: 07/26/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 CEDAR LODGE RD
THOMASVILLE NC
27360-6143
US

IV. Provider business mailing address

502 W PARKWAY AVE
HIGH POINT NC
27262-3032
US

V. Phone/Fax

Practice location:
  • Phone: 336-474-2211
  • Fax:
Mailing address:
  • Phone: 901-264-7542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-19-39545
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-19-39545
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: