Provider Demographics
NPI:1740646272
Name:TAYLOR, KIWANDA JAYNA (MS)
Entity type:Individual
Prefix:
First Name:KIWANDA
Middle Name:JAYNA
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 W AIRLINE HWY
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-3336
Mailing Address - Country:US
Mailing Address - Phone:985-510-3036
Mailing Address - Fax:985-652-2450
Practice Address - Street 1:1809 W AIRLINE HWY
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-3336
Practice Address - Country:US
Practice Address - Phone:985-652-8444
Practice Address - Fax:985-652-2450
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-13
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPLC9697101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional