Healthcare Provider Details

I. General information

NPI: 1700586302
Provider Name (Legal Business Name): ROGELYN TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2023
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 BRADLEY ST NE
CONCORD NC
28025-2979
US

IV. Provider business mailing address

855 BRADLEY ST NE
CONCORD NC
28025-2979
US

V. Phone/Fax

Practice location:
  • Phone: 980-785-1113
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number390
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: