Provider Demographics
NPI:1659110641
Name:TAYLOR, REBECCA GRACE (LCMHC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:GRACE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4149 BROOK CREEK LN UNIT A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-8204
Mailing Address - Country:US
Mailing Address - Phone:252-714-8900
Mailing Address - Fax:
Practice Address - Street 1:4149 BROOK CREEK LN UNIT A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-8204
Practice Address - Country:US
Practice Address - Phone:252-714-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15400101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty