Provider Demographics
NPI:1659806875
Name:TAYLOR, CLIFTON SHAWN (MED, LPCA)
Entity Type:Individual
Prefix:MR
First Name:CLIFTON
Middle Name:SHAWN
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MED, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 EXECUTIVE CIR STE D
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-4586
Mailing Address - Country:US
Mailing Address - Phone:919-249-5423
Mailing Address - Fax:
Practice Address - Street 1:1145 EXECUTIVE CIR STE D
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4586
Practice Address - Country:US
Practice Address - Phone:919-249-5423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12196101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional