Provider Demographics
NPI:1316772809
Name:TAYLOR, LAVENNA (CDCA, CPRS)
Entity type:Individual
Prefix:
First Name:LAVENNA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CDCA, CPRS
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 212
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-0212
Mailing Address - Country:US
Mailing Address - Phone:937-708-8348
Mailing Address - Fax:937-660-5656
Practice Address - Street 1:282 STELTON RD
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-5220
Practice Address - Country:US
Practice Address - Phone:937-708-8348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.004331175T00000X
OHCDCA.188237101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist