Provider Demographics
NPI:1518748276
Name:TAYLOR, FREDRICK D (CDCA)
Entity Type:Individual
Prefix:
First Name:FREDRICK
Middle Name:D
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2837 TANNERY CT
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-3948
Mailing Address - Country:US
Mailing Address - Phone:614-371-9162
Mailing Address - Fax:
Practice Address - Street 1:2837 TANNERY CT
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-3948
Practice Address - Country:US
Practice Address - Phone:614-371-9162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)