Provider Demographics
NPI:1184211740
Name:TAYLOR, VICTORIA SHANNON (LMHC)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:SHANNON
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PLYMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02347-2439
Mailing Address - Country:US
Mailing Address - Phone:781-635-6507
Mailing Address - Fax:
Practice Address - Street 1:10 PLYMOUTH ST
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MA
Practice Address - Zip Code:02347-2439
Practice Address - Country:US
Practice Address - Phone:781-635-6507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2022-09-30
Deactivation Date:2022-01-04
Deactivation Code:
Reactivation Date:2022-09-30
Provider Licenses
StateLicense IDTaxonomies
MA12056101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health