Provider Demographics
NPI:1043718281
Name:TAYLOR, RODERICK (PRC)
Entity Type:Individual
Prefix:
First Name:RODERICK
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 MARTIN LUTHER KING BLVD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48502-2002
Mailing Address - Country:US
Mailing Address - Phone:810-239-7226
Mailing Address - Fax:810-239-5518
Practice Address - Street 1:529 MARTIN LUTHER KING BLVD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48502-2002
Practice Address - Country:US
Practice Address - Phone:810-239-7226
Practice Address - Fax:810-239-5518
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)