Provider Demographics
NPI:1750962015
Name:TAYLOR, JENNIFER CHRISTY (LCMHCA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CHRISTY
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:694 QUICKSILVER TRL
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-6512
Mailing Address - Country:US
Mailing Address - Phone:803-280-5858
Mailing Address - Fax:
Practice Address - Street 1:3800 ARCO CORPORATE DR STE 320
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-3411
Practice Address - Country:US
Practice Address - Phone:704-237-4240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16486101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health