Provider Demographics
NPI:1437636099
Name:WISEMAN, TAYLOR CATHERINE (BS, RBT)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:CATHERINE
Last Name:WISEMAN
Suffix:
Gender:F
Credentials:BS, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2279 PLEASURE HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-2021
Mailing Address - Country:US
Mailing Address - Phone:757-771-1191
Mailing Address - Fax:
Practice Address - Street 1:4490 HOLLAND OFFICE PARK
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1177
Practice Address - Country:US
Practice Address - Phone:757-639-2218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106E00000X
VARBT-18-61479106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst