Provider Demographics
NPI:1205069242
Name:HOLDER, TAYLOR JULIAN (LCSW)
Entity type:Individual
Prefix:MR
First Name:TAYLOR
Middle Name:JULIAN
Last Name:HOLDER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:472D WESTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6824
Mailing Address - Country:US
Mailing Address - Phone:910-238-4513
Mailing Address - Fax:910-238-4745
Practice Address - Street 1:472 WESTERN BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6824
Practice Address - Country:US
Practice Address - Phone:910-238-4513
Practice Address - Fax:910-238-4745
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0053181041C0700X
NCC0074371041C0700X
NC1709101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)