Provider Demographics
NPI:1346830544
Name:LISA TAYLOR LIFE DESIGN NETWORK
Entity Type:Organization
Organization Name:LISA TAYLOR LIFE DESIGN NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MEDLPC, NCC
Authorized Official - Phone:434-483-4380
Mailing Address - Street 1:300 RINGGOLD INDUSTRIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-5548
Mailing Address - Country:US
Mailing Address - Phone:434-483-4380
Mailing Address - Fax:434-793-9200
Practice Address - Street 1:300 RINGGOLD INDUSTRIAL PKWY
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-5548
Practice Address - Country:US
Practice Address - Phone:276-806-1013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty