Provider Demographics
NPI:1891850764
Name:TAYLOR, CAROL DIANNE (LPC, LMFT, LSATP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:DIANNE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LPC, LMFT, LSATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 BROUGH LN APT 101
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-3273
Mailing Address - Country:US
Mailing Address - Phone:757-817-1923
Mailing Address - Fax:
Practice Address - Street 1:2019 CUNNINGHAM DR STE 410
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-3318
Practice Address - Country:US
Practice Address - Phone:757-826-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002424101Y00000X
VA0718000104101YA0400X
VA0717000587106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist