Provider Demographics
NPI:1053806893
Name:TAYLOR, ANGELA LYNETTE
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:LYNETTE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12388 WARWICK BLVD STE 212
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-3857
Mailing Address - Country:US
Mailing Address - Phone:757-609-1076
Mailing Address - Fax:
Practice Address - Street 1:12388 WARWICK BLVD STE 212
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3857
Practice Address - Country:US
Practice Address - Phone:757-609-1076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health