Provider Demographics
NPI:1497343602
Name:TAYLOR, COURTNEY M (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:M
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 SAINT JAMES DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-2937
Mailing Address - Country:US
Mailing Address - Phone:910-660-8200
Mailing Address - Fax:910-660-8199
Practice Address - Street 1:720 SAINT JAMES DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2937
Practice Address - Country:US
Practice Address - Phone:910-660-8200
Practice Address - Fax:910-660-8199
Is Sole Proprietor?:No
Enumeration Date:2021-01-04
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1-21-47816103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst