Provider Demographics
NPI:1114064045
Name:TAYLOR, EMMIE LOU (LCSW)
Entity Type:Individual
Prefix:MS
First Name:EMMIE
Middle Name:LOU
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 MOUNT GOULD RIVER RD
Mailing Address - Street 2:
Mailing Address - City:MERRY HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27957-9658
Mailing Address - Country:US
Mailing Address - Phone:252-356-2813
Mailing Address - Fax:
Practice Address - Street 1:239 MOUNT GOULD RIVER RD
Practice Address - Street 2:
Practice Address - City:MERRY HILL
Practice Address - State:NC
Practice Address - Zip Code:27957-9658
Practice Address - Country:US
Practice Address - Phone:252-356-2813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0016651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106159Medicaid
NC6106159Medicaid