Basic Information
| Provider Information | |||||||||
| NPI: | 1023674330 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | CDCA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1825 THREE TOWERS RD | ||||||||
| Address2: | |||||||||
| City: | CHANDLERSVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437279671 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7402975789 | ||||||||
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| Practice Location | |||||||||
| Address1: | 927 WHEELING AVE STE 310 | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437252340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404394532 | ||||||||
| FaxNumber: | 7404391031 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2019 | ||||||||
| LastUpdateDate: | 05/13/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 170342 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.