Provider Demographics
NPI:1710250485
Name:TAYLOR, ERNESTINE SMITH (LCAS)
Entity Type:Individual
Prefix:
First Name:ERNESTINE
Middle Name:SMITH
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 SAINT ANDREWS DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-6326
Mailing Address - Country:US
Mailing Address - Phone:252-341-2397
Mailing Address - Fax:
Practice Address - Street 1:103 SAINT ANDREWS DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-6326
Practice Address - Country:US
Practice Address - Phone:252-341-2397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1983101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)