Healthcare Provider Details

I. General information

NPI: 1245464023
Provider Name (Legal Business Name): WILLIAM L. TAYLOR JR. ED.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2009
Last Update Date: 05/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12305 DEXTER AVE
DETROIT MI
48206-1015
US

IV. Provider business mailing address

12305 DEXTER AVE
DETROIT MI
48206-1015
US

V. Phone/Fax

Practice location:
  • Phone: 313-397-1306
  • Fax: 313-397-6010
Mailing address:
  • Phone: 313-397-1306
  • Fax: 313-397-6010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: