Healthcare Provider Details

I. General information

NPI: 1962028175
Provider Name (Legal Business Name): TAYLOR LEIGH EDMAN LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TAYLOR LEIGH LORENZO

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 GREENWAY ST NW STE 5
GLEN BURNIE MD
21061-3557
US

IV. Provider business mailing address

705 JESSIE CT
BEL AIR MD
21014-2746
US

V. Phone/Fax

Practice location:
  • Phone: 410-760-9097
  • Fax:
Mailing address:
  • Phone: 410-652-1813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC12811
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: