Provider Demographics
NPI:1649499369
Name:TAYLOR, LAURA C
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:C
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 1:2602 N SHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2137
Mailing Address - Country:US
Mailing Address - Phone:229-630-6491
Mailing Address - Fax:
Practice Address - Street 1:2602 N SHERWOOD DR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2137
Practice Address - Country:US
Practice Address - Phone:229-630-6491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker