Provider Demographics
NPI:1447203211
Name:TAYLOR, GINGER DAWN (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:GINGER
Middle Name:DAWN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4608 CEDAR AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4419
Mailing Address - Country:US
Mailing Address - Phone:910-619-3113
Mailing Address - Fax:910-793-8767
Practice Address - Street 1:4608 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4419
Practice Address - Country:US
Practice Address - Phone:910-619-3113
Practice Address - Fax:910-793-8767
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0037761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1321JOtherBLUE CROSS BLUE SHIELD
NC475534000OtherMAGELLAN
NC6002452Medicaid
NC1321JOtherBLUE CROSS BLUE SHIELD