Provider Demographics
NPI:1669004776
Name:TAYLOR, TYLER SANELLE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TYLER
Middle Name:SANELLE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14321 WINTER BREEZE DR STE 165
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-2452
Mailing Address - Country:US
Mailing Address - Phone:804-774-7063
Mailing Address - Fax:804-774-7066
Practice Address - Street 1:14321 WINTER BREEZE DR STE 165
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-2452
Practice Address - Country:US
Practice Address - Phone:804-774-7063
Practice Address - Fax:804-774-7066
Is Sole Proprietor?:No
Enumeration Date:2020-02-06
Last Update Date:2022-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0906007322104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker