Provider Demographics
NPI:1740420900
Name:TAYLOR, JACINTA EVELYN (BA)
Entity Type:Individual
Prefix:
First Name:JACINTA
Middle Name:EVELYN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4812 W WELLS ST
Mailing Address - Street 2:APT 1
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-3031
Mailing Address - Country:US
Mailing Address - Phone:919-395-4594
Mailing Address - Fax:
Practice Address - Street 1:7CS COUNSELING CLINICS 561 N. 15TH ST
Practice Address - Street 2:ROOM 171A
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233
Practice Address - Country:US
Practice Address - Phone:414-288-4556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15539-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)