Provider Demographics
NPI:1891145876
Name:TAYLOR ENHANCED LIVING
Entity Type:Organization
Organization Name:TAYLOR ENHANCED LIVING
Other - Org Name:TAYLOR STARKEWOOD ENTERPRISES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARITA
Authorized Official - Middle Name:LAVONNE
Authorized Official - Last Name:THREATT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:804-733-8847
Mailing Address - Street 1:105 HOLLY HILL DIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805
Mailing Address - Country:US
Mailing Address - Phone:804-733-8847
Mailing Address - Fax:804-732-4963
Practice Address - Street 1:105 HOLLY HILL DIVE
Practice Address - Street 2:SUITE A
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805
Practice Address - Country:US
Practice Address - Phone:804-733-8847
Practice Address - Fax:804-732-4963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006556101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty