Provider Demographics
NPI:1982151569
Name:TAYLOR, CHANTELLE (LCPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:CHANTELLE
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7335 MAIN STREET
Mailing Address - Street 2:SUITE 1F
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-9513
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7335 MAIN STREET
Practice Address - Street 2:SUITE 1F
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21785-9513
Practice Address - Country:US
Practice Address - Phone:410-970-6964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC6680101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional