Provider Demographics
NPI:1174494991
Name:TAYLOR, CARLA (LSATP)
Entity type:Individual
Prefix:MS
First Name:CARLA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LSATP
Other - Prefix:MS
Other - First Name:CARLA
Other - Middle Name:
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3709 PEPPERCORN WAY
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321
Mailing Address - Country:US
Mailing Address - Phone:757-641-2446
Mailing Address - Fax:
Practice Address - Street 1:4212 PARK PLACE CT.
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060
Practice Address - Country:US
Practice Address - Phone:804-315-3135
Practice Address - Fax:804-728-1086
Is Sole Proprietor?:No
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0718000620101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor