Healthcare Provider Details

I. General information

NPI: 1548684897
Provider Name (Legal Business Name): TIYANA KIA CHANEY-TAYLOR PHD, LCSW, BC-TMH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2014
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S COLLEGE RD
WILMINGTON NC
28403-3201
US

IV. Provider business mailing address

304 HOLIDAY DR
HAMPSTEAD NC
28443-3582
US

V. Phone/Fax

Practice location:
  • Phone: 910-962-2901
  • Fax:
Mailing address:
  • Phone: 910-382-9450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW007453
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC018643
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1895
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number16453
License Number StateSC
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7392
License Number StateTN
# 6
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number6689
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: