Provider Demographics
NPI:1962880476
Name:TAYLOR, JANAE (PHD)
Entity type:Individual
Prefix:
First Name:JANAE
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 SHORE DR
Mailing Address - Street 2:SUITE 103 #230
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-2891
Mailing Address - Country:US
Mailing Address - Phone:757-563-3137
Mailing Address - Fax:
Practice Address - Street 1:328 OFFICE SQUARE LN
Practice Address - Street 2:SUITE 104
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-3648
Practice Address - Country:US
Practice Address - Phone:757-563-3137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-16
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006122101YP2500X
GALPC006866101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional