Provider Demographics
NPI:1528556586
Name:TAYLOR, JAZMONE SHERECE (JD, LGPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:JAZMONE
Middle Name:SHERECE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:JD, LGPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7474 GREENWAY CENTER DR STE 730
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3523
Mailing Address - Country:US
Mailing Address - Phone:301-345-1022
Mailing Address - Fax:301-560-5558
Practice Address - Street 1:5820 YORK RD STE 202
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-3620
Practice Address - Country:US
Practice Address - Phone:301-345-1022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP7745101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional