Provider Demographics
NPI:1386204634
Name:TAYLOR, CARLY IRENE (CDCA)
Entity type:Individual
Prefix:MRS
First Name:CARLY
Middle Name:IRENE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:MISS
Other - First Name:CARLY
Other - Middle Name:IRENE
Other - Last Name:ONTKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CDCA
Mailing Address - Street 1:1086 GLENDALE DR
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-1432
Mailing Address - Country:US
Mailing Address - Phone:513-818-5128
Mailing Address - Fax:
Practice Address - Street 1:25 WHITNEY DR STE 120
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-8400
Practice Address - Country:US
Practice Address - Phone:513-753-9964
Practice Address - Fax:888-450-1488
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.173221101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)