Provider Demographics
NPI:1073109922
Name:KRACHT, TAYLOR M
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:M
Last Name:KRACHT
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 1:5630 SAGE HILLS DR APT 914
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-0614
Mailing Address - Country:US
Mailing Address - Phone:267-221-8881
Mailing Address - Fax:
Practice Address - Street 1:5630 SAGE HILLS DR APT 914
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-0614
Practice Address - Country:US
Practice Address - Phone:267-221-8881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health