Provider Demographics
NPI:1760658603
Name:TAYLOR, VALERIA JONES
Entity Type:Individual
Prefix:MS
First Name:VALERIA
Middle Name:JONES
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2181 PHILLIPS FARM RD
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-7249
Mailing Address - Country:US
Mailing Address - Phone:252-775-1446
Mailing Address - Fax:252-527-5990
Practice Address - Street 1:306 E LENOIR AVE
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-4425
Practice Address - Country:US
Practice Address - Phone:252-775-1446
Practice Address - Fax:252-527-5990
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC063228320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities