Provider Demographics
NPI:1609257898
Name:TAYLOR, CLEVELAND HARRIS JR (BA)
Entity Type:Individual
Prefix:MR
First Name:CLEVELAND
Middle Name:HARRIS
Last Name:TAYLOR
Suffix:JR
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 FAIRWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-5108
Mailing Address - Country:US
Mailing Address - Phone:804-334-6611
Mailing Address - Fax:
Practice Address - Street 1:114 FAIRWOOD DR
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-5108
Practice Address - Country:US
Practice Address - Phone:804-334-6611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-12
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VACRF-471101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health