Healthcare Provider Details

I. General information

NPI: 1669942892
Provider Name (Legal Business Name): MICHELLE ANN TAYLOR LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2018
Last Update Date: 11/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BREAKTHROUGH COUNSELING SERVICES 4014 MOUNTVILLE ROAD
JEFFERSON MD
21755-7713
US

IV. Provider business mailing address

11718 SCARLET LEAF CIR
GERMANTOWN MD
20876-6049
US

V. Phone/Fax

Practice location:
  • Phone: 240-986-1001
  • Fax:
Mailing address:
  • Phone: 301-503-2854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberG08031
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: