Provider Demographics
NPI:1912168063
Name:TAYLOR, LINDA FOX (MED)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:FOX
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12419 PENROSE TRL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-8824
Mailing Address - Country:US
Mailing Address - Phone:919-761-8299
Mailing Address - Fax:919-761-8299
Practice Address - Street 1:12419 PENROSE TRL
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-8824
Practice Address - Country:US
Practice Address - Phone:919-761-8299
Practice Address - Fax:919-761-8299
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-21
Last Update Date:2008-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3095101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor