Provider Demographics
NPI:1285859603
Name:TAYLOR, TERI (LGSW, CCDC)
Entity Type:Individual
Prefix:MS
First Name:TERI
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LGSW, CCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6132 FISHHAWK CROSSING BLVD
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-4880
Mailing Address - Country:US
Mailing Address - Phone:813-662-9828
Mailing Address - Fax:
Practice Address - Street 1:4700 N HABANA AVE STE 500
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7120
Practice Address - Country:US
Practice Address - Phone:813-801-3915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDG12442104100000X
MD0684101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker