Healthcare Provider Details

I. General information

NPI: 1164334157
Provider Name (Legal Business Name): TAYLOR CARRILLO LCSW-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7672 NC HIGHWAY 105 S
BOONE NC
28607-7330
US

IV. Provider business mailing address

1047 LAND HBR
NEWLAND NC
28657-7901
US

V. Phone/Fax

Practice location:
  • Phone: 828-832-6366
  • Fax:
Mailing address:
  • Phone: 307-749-3027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP024429
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: