Healthcare Provider Details

I. General information

NPI: 1932978079
Provider Name (Legal Business Name): TAYLOR LANIECE THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/01/2024
Last Update Date: 01/01/2024
Certification Date: 12/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 FREDERICK AVE
AKRON OH
44310-2904
US

IV. Provider business mailing address

1282 NOME AVE
AKRON OH
44320-3349
US

V. Phone/Fax

Practice location:
  • Phone: 330-996-7730
  • Fax:
Mailing address:
  • Phone: 313-433-8786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: