Provider Demographics
NPI:1881394088
Name:TAYLOR, BREA VERNELL (LCSWA, MSW, BSW)
Entity type:Individual
Prefix:
First Name:BREA
Middle Name:VERNELL
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LCSWA, MSW, BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BOBWHITE CT
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:NC
Mailing Address - Zip Code:27504-6756
Mailing Address - Country:US
Mailing Address - Phone:301-789-3883
Mailing Address - Fax:
Practice Address - Street 1:1915 CHAPEL HILL RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-1177
Practice Address - Country:US
Practice Address - Phone:919-246-5664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP018730101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health