Provider Demographics
NPI:1629854625
Name:WHORTAN, MARGUERITE TAYLOR
Entity Type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:TAYLOR
Last Name:WHORTAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3117 ARCHDALE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-4651
Mailing Address - Country:US
Mailing Address - Phone:704-576-5497
Mailing Address - Fax:
Practice Address - Street 1:7202 KINLEY COMMONS LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278-2501
Practice Address - Country:US
Practice Address - Phone:704-576-5497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician