Healthcare Provider Details

I. General information

NPI: 1366864563
Provider Name (Legal Business Name): ZACHARY ROSS TAYLOR LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2014
Last Update Date: 06/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 NORTHRIDGE LN
LEXINGTON VA
24450-3399
US

IV. Provider business mailing address

29 LEXINGTON AVE
LEXINGTON VA
24450-2243
US

V. Phone/Fax

Practice location:
  • Phone: 540-464-8700
  • Fax:
Mailing address:
  • Phone: 434-242-8697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701005699
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: