Provider Demographics
NPI:1356044705
Name:CAMPBELL, SARAH NICOLE (BCBA)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:NICOLE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7255 JETTY LN APT 209
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-1113
Mailing Address - Country:US
Mailing Address - Phone:779-704-1370
Mailing Address - Fax:
Practice Address - Street 1:240 RACINE DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-8703
Practice Address - Country:US
Practice Address - Phone:910-202-4103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-24
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
BACB813167106S00000X
106S00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician