Healthcare Provider Details

I. General information

NPI: 1932662020
Provider Name (Legal Business Name): CASEY TAYLOR WEST MA, LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2019
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 GANNAWAY ST
JAMESTOWN NC
27282-9866
US

IV. Provider business mailing address

101 GANNAWAY ST
JAMESTOWN NC
27282-9866
US

V. Phone/Fax

Practice location:
  • Phone: 336-484-1753
  • Fax:
Mailing address:
  • Phone: 336-484-1753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14749
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: