Provider Demographics
NPI:1639480411
Name:TAYLOR, KELLY GIBSON
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:GIBSON
Last Name:TAYLOR
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 1:2050 EASTGATE DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-4283
Mailing Address - Country:US
Mailing Address - Phone:252-353-8452
Mailing Address - Fax:252-353-8457
Practice Address - Street 1:2050 EASTGATE DR
Practice Address - Street 2:SUITE E
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-4283
Practice Address - Country:US
Practice Address - Phone:252-353-8452
Practice Address - Fax:252-353-8457
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist