Provider Demographics
NPI:1982818308
Name:TAYLOR, SANDRA J (LADC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:J
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SEACLIFF AVENUE
Mailing Address - Street 2:UNIT 7A
Mailing Address - City:OLD ORCHARD BEACH
Mailing Address - State:ME
Mailing Address - Zip Code:04064
Mailing Address - Country:US
Mailing Address - Phone:207-730-2647
Mailing Address - Fax:
Practice Address - Street 1:650 MAIN STREET
Practice Address - Street 2:SUITE 103
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106
Practice Address - Country:US
Practice Address - Phone:207-774-4564
Practice Address - Fax:207-774-0006
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC2706101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)