Healthcare Provider Details

I. General information

NPI: 1033571740
Provider Name (Legal Business Name): BERNARD TAYLOR LICDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 07/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2180 ROMIG RD
AKRON OH
44320
US

IV. Provider business mailing address

2180 ROMIG RD
AKRON OH
44320-3879
US

V. Phone/Fax

Practice location:
  • Phone: 330-745-5488
  • Fax:
Mailing address:
  • Phone: 234-334-3406
  • Fax: 234-334-3456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: