Healthcare Provider Details

I. General information

NPI: 1205462157
Provider Name (Legal Business Name): D'ANGELO TAYLOR LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2020
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S REYNOLDS ST APT 405
ALEXANDRIA VA
22304-3173
US

IV. Provider business mailing address

447 E 12TH ST APT 213
CHARLOTTE NC
28206-0506
US

V. Phone/Fax

Practice location:
  • Phone: 910-584-9500
  • Fax:
Mailing address:
  • Phone: 910-584-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPRC15306
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPRC15306
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPRC15306
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: