Healthcare Provider Details

I. General information

NPI: 1821605460
Provider Name (Legal Business Name): TAYLOR JEAN-CHARLES LMHC-D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 LAKEFRONT LN
SALISBURY MD
21804-2456
US

IV. Provider business mailing address

500 LAKEFRONT LN APT 107
SALISBURY MD
21804-2457
US

V. Phone/Fax

Practice location:
  • Phone: 845-300-6981
  • Fax:
Mailing address:
  • Phone: 845-300-6981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number012909
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: