Provider Demographics
NPI:1629416813
Name:TAYLOR, TONYA MICHELE (LCMHC)
Entity Type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:MICHELE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 CASTLEPOINTE DR
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-3827
Mailing Address - Country:US
Mailing Address - Phone:919-255-5189
Mailing Address - Fax:
Practice Address - Street 1:1144 EXECUTIVE CIR # 241
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4573
Practice Address - Country:US
Practice Address - Phone:919-255-5189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10187101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty