Provider Demographics
NPI:1427869692
Name:TAYLOR, GWENDOLYN SHAUDRE
Entity type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:SHAUDRE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GWENDOLYN
Other - Middle Name:SHAUDRE
Other - Last Name:DORSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4484 KELLYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-7055
Mailing Address - Country:US
Mailing Address - Phone:912-281-9723
Mailing Address - Fax:
Practice Address - Street 1:4484 KELLYBROOK DR
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-7055
Practice Address - Country:US
Practice Address - Phone:912-281-9723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP015228104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker