Provider Demographics
NPI:1083941652
Name:HARRIS-KROLL, NANCY SUZANNE (MSED, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:SUZANNE
Last Name:HARRIS-KROLL
Suffix:
Gender:F
Credentials:MSED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 FIRST COLONIAL RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3111
Mailing Address - Country:US
Mailing Address - Phone:757-428-3367
Mailing Address - Fax:757-428-1630
Practice Address - Street 1:909 FIRST COLONIAL RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3111
Practice Address - Country:US
Practice Address - Phone:757-428-3367
Practice Address - Fax:757-428-1630
Is Sole Proprietor?:No
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1095805174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist