Provider Demographics
NPI:1659883361
Name:TAYLOR, CAPRA ZELEANOR (BACHELOR OF SCIENCE)
Entity Type:Individual
Prefix:
First Name:CAPRA
Middle Name:ZELEANOR
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:BACHELOR OF SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 POWDERHORN RD
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-3399
Mailing Address - Country:US
Mailing Address - Phone:864-299-0716
Mailing Address - Fax:
Practice Address - Street 1:20 POWDERHORN RD
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-3399
Practice Address - Country:US
Practice Address - Phone:864-299-0716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-03
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty