Provider Demographics
NPI:1699397968
Name:TAYLOR, ANDREYA MARIE (LCSW, LISW-CP)
Entity Type:Individual
Prefix:
First Name:ANDREYA
Middle Name:MARIE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LCSW, LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201A S TOWNVILLE ST
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-3421
Mailing Address - Country:US
Mailing Address - Phone:409-350-8973
Mailing Address - Fax:
Practice Address - Street 1:130 4TH AVE APT 4
Practice Address - Street 2:
Practice Address - City:HAVRE
Practice Address - State:MT
Practice Address - Zip Code:59501-3661
Practice Address - Country:US
Practice Address - Phone:409-350-8973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-10
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC135841041C0700X
MTBBH-LCSW-LIC-391111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical