Provider Demographics
NPI:1629808589
Name:TAYLOR, CHASE BRADLEY (MHS, BA, LCMHCA, NCC)
Entity type:Individual
Prefix:
First Name:CHASE
Middle Name:BRADLEY
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MHS, BA, LCMHCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:638 BRAWLEY RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:NC
Mailing Address - Zip Code:27013-8705
Mailing Address - Country:US
Mailing Address - Phone:704-213-6428
Mailing Address - Fax:
Practice Address - Street 1:638 BRAWLEY RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:NC
Practice Address - Zip Code:27013-8705
Practice Address - Country:US
Practice Address - Phone:704-213-6428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-06
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA20167101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health