Provider Demographics
NPI:1124183298
Name:TAYLOR, ROKETTA L (CSC)
Entity Type:Individual
Prefix:
First Name:ROKETTA
Middle Name:L
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 BOOTH ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-3003
Mailing Address - Country:US
Mailing Address - Phone:443-523-7494
Mailing Address - Fax:
Practice Address - Street 1:1001 LAKE ST
Practice Address - Street 2:CENTER 4 CLEAN START
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-3141
Practice Address - Country:US
Practice Address - Phone:410-742-3460
Practice Address - Fax:410-742-5810
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDSC1431101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS013Medicare ID - Type Unspecified