Provider Demographics
NPI:1619463171
Name:TAYLOR, SAMANTHA LEE-ANN (CDCA)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LEE-ANN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 BRICE RD
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-3403
Mailing Address - Country:US
Mailing Address - Phone:614-239-9965
Mailing Address - Fax:614-239-9971
Practice Address - Street 1:1900 BRICE RD
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-3403
Practice Address - Country:US
Practice Address - Phone:614-239-9965
Practice Address - Fax:614-239-9971
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH164417101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty