Healthcare Provider Details

I. General information

NPI: 1124340625
Provider Name (Legal Business Name): MISS HALEY NICOLE TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HALEY NICOLE CARTER

II. Dates (important events)

Enumeration Date: 02/24/2010
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 GATEWAY CENTER WAY STE 300
SAN DIEGO CA
92102-4550
US

IV. Provider business mailing address

995 GATEWAY CENTER WAY STE 300 300
SAN DIEGO CA
92102-4550
US

V. Phone/Fax

Practice location:
  • Phone: 619-398-2156
  • Fax:
Mailing address:
  • Phone: 619-398-2156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-ZGTAUF
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: