Provider Demographics
NPI:1588970065
Name:TAYLOR, CHANDRA LATRICE (LCPC, NCC)
Entity type:Individual
Prefix:MS
First Name:CHANDRA
Middle Name:LATRICE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4248 W 77TH ST APT 301
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60652-1378
Mailing Address - Country:US
Mailing Address - Phone:312-520-1335
Mailing Address - Fax:773-884-0490
Practice Address - Street 1:4248 W 77TH ST APT 301
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60652-1378
Practice Address - Country:US
Practice Address - Phone:312-520-1335
Practice Address - Fax:773-884-0490
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007187101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health