Provider Demographics
NPI:1205876836
Name:TAYLOR, ALFRED JERRY (LCMFT)
Entity type:Individual
Prefix:MR
First Name:ALFRED
Middle Name:JERRY
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 CONOWINGO RD
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-2648
Mailing Address - Country:US
Mailing Address - Phone:410-838-4674
Mailing Address - Fax:
Practice Address - Street 1:2018 ROCK SPRING RD
Practice Address - Street 2:SUITE A6
Practice Address - City:FOREST HILL
Practice Address - State:MD
Practice Address - Zip Code:21050-2631
Practice Address - Country:US
Practice Address - Phone:410-838-2493
Practice Address - Fax:410-838-2597
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCM002170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS