Provider Demographics
NPI:1164202776
Name:TAYLOR, ROBERT DOUGLAS JR (CSAC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DOUGLAS
Last Name:TAYLOR
Suffix:JR
Gender:M
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2219 SHIPS XING
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-4028
Mailing Address - Country:US
Mailing Address - Phone:757-582-6535
Mailing Address - Fax:
Practice Address - Street 1:104 HOLCOMB ROAD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23708-0000
Practice Address - Country:US
Practice Address - Phone:757-953-4903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710103826101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)