Healthcare Provider Details

I. General information

NPI: 1366408718
Provider Name (Legal Business Name): DEBORAH JEAN TAYLOR PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 06/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15444 US HWY. 17 N BLDG. 16
HAMPSTEAD NC
28443-8250
US

IV. Provider business mailing address

5010 RANDALL PARKWAY
WILMINGTON NC
28403-2829
US

V. Phone/Fax

Practice location:
  • Phone: 910-270-5505
  • Fax: 910-270-5496
Mailing address:
  • Phone: 910-791-5719
  • Fax: 910-799-8180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2791
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: