Provider Demographics
NPI:1184656365
Name:TAYLOR, NANCY
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:TAYLOR
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 1:230 E POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-3646
Mailing Address - Country:US
Mailing Address - Phone:336-705-9848
Mailing Address - Fax:336-705-9848
Practice Address - Street 1:319 S MAIN STREET #201
Practice Address - Street 2:
Practice Address - City:MT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-3850
Practice Address - Country:US
Practice Address - Phone:336-705-9848
Practice Address - Fax:336-755-2419
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4035101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102324Medicaid