Provider Demographics
NPI:1235285297
Name:TAYLOR, JAIME WARD (QP, BS)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:WARD
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:QP, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1128 PADDINGTON PL
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-6304
Mailing Address - Country:US
Mailing Address - Phone:910-670-5625
Mailing Address - Fax:910-893-3474
Practice Address - Street 1:62 IDA BROWN LANE
Practice Address - Street 2:
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546
Practice Address - Country:US
Practice Address - Phone:910-814-0044
Practice Address - Fax:910-893-3474
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3409081101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health