Provider Demographics
NPI:1528651346
Name:TAYLOR, DEBRA CHARLENE
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:CHARLENE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
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 162
Mailing Address - Street 2:
Mailing Address - City:CANVAS
Mailing Address - State:WV
Mailing Address - Zip Code:26662-0162
Mailing Address - Country:US
Mailing Address - Phone:304-651-6685
Mailing Address - Fax:
Practice Address - Street 1:4663 CANVAS NETTIE RD
Practice Address - Street 2:
Practice Address - City:CANVAS
Practice Address - State:WV
Practice Address - Zip Code:26662-4114
Practice Address - Country:US
Practice Address - Phone:304-872-0106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-12
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No172V00000XOther Service ProvidersCommunity Health Worker