Provider Demographics
NPI:1215215447
Name:TAYLOR, JOHN T (LMSW, CAC I)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:T
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:LMSW, CAC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 COOK RD
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-2124
Mailing Address - Country:US
Mailing Address - Phone:803-536-4900
Mailing Address - Fax:803-536-4980
Practice Address - Street 1:910 COOK RD
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-2124
Practice Address - Country:US
Practice Address - Phone:803-536-4900
Practice Address - Fax:803-536-4980
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0071481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical