MEDICARE: JANAE TAYLOR PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	0701006122	VA
2	101YP2500X	Professional Counselor	LPC006866	GA

General Provider Information

NPI Number	:	1962880476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANAE TAYLOR PHD

Provider Business Mailing Address
First Line	:	4701 SHORE DR
Second Line	:	SUITE 103 #230
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-2891
Country	:	US
Telephone Number	:	757-563-3137
Fax Number	:

Provider Business Practice Location Address
First Line	:	328 OFFICE SQUARE LN
Second Line	:	SUITE 104
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-3648
Country	:	US
Telephone Number	:	757-563-3137
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2015
Last Update Date	:	01/24/2017

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Directions to “ JANAE TAYLOR PHD” Practice Location

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