Provider Demographics
NPI:1932182367
Name:TAYLOR, CARVEL U (LCSW CAC)
Entity Type:Individual
Prefix:MS
First Name:CARVEL
Middle Name:U
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LCSW CAC
Other - Prefix:MS
Other - First Name:CARVEL
Other - Middle Name:U
Other - Last Name:TAYLOR-VALENTINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW CAC
Mailing Address - Street 1:1500 LITTLE CREEK ROAD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:NORTOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23518
Mailing Address - Country:US
Mailing Address - Phone:757-587-4744
Mailing Address - Fax:757-587-4947
Practice Address - Street 1:1500 LITTLE CREEK ROAD
Practice Address - Street 2:SUITE 205
Practice Address - City:NORTOLK
Practice Address - State:VA
Practice Address - Zip Code:23518
Practice Address - Country:US
Practice Address - Phone:757-587-4744
Practice Address - Fax:757-587-4947
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA89309101YA0400X
VA0904002856104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA215757OtherANTHEM BC
VA008923868Medicaid
VA215757OtherANTHEM BC
VA008923868Medicaid