Provider Demographics
NPI:1396412821
Name:TAYLOR, MARTINA D (LPC)
Entity type:Individual
Prefix:
First Name:MARTINA
Middle Name:D
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MARTINA
Other - Middle Name:DENICE
Other - Last Name:MEEKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:2509 FARRAND ST
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23231-3126
Mailing Address - Country:US
Mailing Address - Phone:757-681-4044
Mailing Address - Fax:
Practice Address - Street 1:4912 W BROAD ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3126
Practice Address - Country:US
Practice Address - Phone:804-313-6767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701013712101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0704014207OtherVA DEPT HEALTH PROFESSIONALS