Provider Demographics
NPI:1306686456
Name:TAYLOR, LAURA (MCP, LGPC)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MCP, LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 42
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:MD
Mailing Address - Zip Code:21018-0042
Mailing Address - Country:US
Mailing Address - Phone:443-903-2166
Mailing Address - Fax:
Practice Address - Street 1:5000 THAYER CTR STE C
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-1139
Practice Address - Country:US
Practice Address - Phone:443-903-2166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP14872101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health