Basic Information
| Provider Information | |||||||||
| NPI: | 1467090233 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLLINGSWORTH | ||||||||
| FirstName: | TAYLOR | ||||||||
| MiddleName: | |||||||||
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| Credential: | LGPC, LGPAT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7474 GREENWAY CENTER DR STE 700B | ||||||||
| Address2: | |||||||||
| City: | GREENBELT | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207703523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2403043327 | ||||||||
| FaxNumber: | 2405134155 | ||||||||
| Practice Location | |||||||||
| Address1: | 4800 ROLAND AVE STE 301 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212102347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103246809 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2019 | ||||||||
| LastUpdateDate: | 04/05/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | LGP9672 | MD | N | Behavioral Health & Social Service Providers | Counselor | Professional | 221700000X | ATG232 | MD | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Art Therapist | 221700000X | ATC300 | MD | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Art Therapist | 101Y00000X | LC11703 | MD | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.