Provider Demographics
NPI:1225815012
Name:TAYLOR, KATHY ANN (LCSWA)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:ANN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 DARBY CREEK LN APT 411
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-9459
Mailing Address - Country:US
Mailing Address - Phone:919-867-0360
Mailing Address - Fax:877-920-1934
Practice Address - Street 1:12339 WAKE UNION CHURCH RD STE 111
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-4512
Practice Address - Country:US
Practice Address - Phone:919-867-0360
Practice Address - Fax:877-920-1934
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP018800171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator