Provider Demographics
NPI:1568737997
Name:TAYLOR, KENESHA LASHETTE (CSC-AD, PROV)
Entity Type:Individual
Prefix:
First Name:KENESHA
Middle Name:LASHETTE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CSC-AD, PROV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:SNOW HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21863-0249
Mailing Address - Country:US
Mailing Address - Phone:410-632-1100
Mailing Address - Fax:410-632-2476
Practice Address - Street 1:11827 OCEAN GTWY
Practice Address - Street 2:
Practice Address - City:OCEAN CITY
Practice Address - State:MD
Practice Address - Zip Code:21842-9529
Practice Address - Country:US
Practice Address - Phone:410-213-0202
Practice Address - Fax:410-213-1408
Is Sole Proprietor?:No
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)