Provider Demographics
NPI:1043984040
Name:CAMPBELL, SHAROLYN R
Entity Type:Individual
Prefix:
First Name:SHAROLYN
Middle Name:R
Last Name: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:PO BOX 493
Mailing Address - Street 2:
Mailing Address - City:ROWLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28383-0493
Mailing Address - Country:US
Mailing Address - Phone:191-028-0545
Mailing Address - Fax:
Practice Address - Street 1:310 SOUTH MLK JR STREET
Practice Address - Street 2:310 MLK JR STREET
Practice Address - City:ROWLAND
Practice Address - State:NC
Practice Address - Zip Code:28383-2838
Practice Address - Country:US
Practice Address - Phone:191-028-0545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NC27301101YA0400X
NCLCAS27301101YA0400X
NCLCAS-A27301101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)