Basic Information
| Provider Information | |||||||||
| NPI: | 1144786302 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHRISTINA L TAYLOR, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 HULLIHEN DR | ||||||||
| Address2: | |||||||||
| City: | ELKTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 219212003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2404814525 | ||||||||
| FaxNumber: | 4107931599 | ||||||||
| Practice Location | |||||||||
| Address1: | 282 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197117311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4439876557 | ||||||||
| FaxNumber: | 4107931599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2019 | ||||||||
| LastUpdateDate: | 02/13/2019 | ||||||||
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| AuthorizedOfficialLastName: | TAYLOR | ||||||||
| AuthorizedOfficialFirstName: | CHRISTINA | ||||||||
| AuthorizedOfficialMiddleName: | LOLITA | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4439876557 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCPC, LPCMH | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.