Healthcare Provider Details

I. General information

NPI: 1346755022
Provider Name (Legal Business Name): PHYLLIS GAIL TAYLOR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2017
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 W PERIMETER RD
JB ANDREWS MD
20762-6602
US

IV. Provider business mailing address

4505 MAIN ST STE 313
VIRGINIA BEACH VA
23462-3380
US

V. Phone/Fax

Practice location:
  • Phone: 202-284-3158
  • Fax:
Mailing address:
  • Phone: 850-597-1929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904010059
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: