Provider Demographics
NPI:1821499427
Name:TAYLOR, DOROTHY
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
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 1:4TH MDG
Mailing Address - Street 2:2803 MEDICAL CAMPUS DRIVE
Mailing Address - City:SEYMORE JOHNSON AIR FORCE BASE
Mailing Address - State:NC
Mailing Address - Zip Code:27531
Mailing Address - Country:US
Mailing Address - Phone:919-722-8775
Mailing Address - Fax:
Practice Address - Street 1:4TH MDG
Practice Address - Street 2:2803 MEDICAL CAMPUS DRIVE
Practice Address - City:SEYMORE JOHNSON AIR FORCE BASE
Practice Address - State:NC
Practice Address - Zip Code:27531
Practice Address - Country:US
Practice Address - Phone:919-722-8775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
COCSW099280151041C0700X
NCC0169031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC016903OtherLICENSE CLINICAL SOCIAL WORKER
COCSW09928015OtherLICENSE CLINICAL SOCIAL WORKER