Provider Demographics
NPI:1548684897
Name:CHANEY-TAYLOR, TIYANA KIA (PHD, LCSW)
Entity type:Individual
Prefix:DR
First Name:TIYANA
Middle Name:KIA
Last Name:CHANEY-TAYLOR
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 HOLIDAY DR
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-3582
Mailing Address - Country:US
Mailing Address - Phone:910-382-9450
Mailing Address - Fax:
Practice Address - Street 1:601 S COLLEGE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-3201
Practice Address - Country:US
Practice Address - Phone:910-962-2901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-06
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1895103T00000X
GACSW0074531041C0700X
TN73921041C0700X
SC164531041C0700X
NC6689103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical