Provider Demographics
NPI:1316327752
Name:GULLEY, TAYLOR M (LCSW)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:M
Last Name:GULLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1867 REMOUNT RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-7401
Mailing Address - Country:US
Mailing Address - Phone:704-865-3848
Mailing Address - Fax:704-854-3086
Practice Address - Street 1:1895 HOFFMAN RD
Practice Address - Street 2:SUITE C
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-6557
Practice Address - Country:US
Practice Address - Phone:704-865-3848
Practice Address - Fax:704-854-3086
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NCLCAS-20636101YA0400X
NCP0096551041C0700X
NCC0109021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)