Healthcare Provider Details

I. General information

NPI: 1700307592
Provider Name (Legal Business Name): TAYLOR CHRISTINE TEMPLIN-VIELE EDS., NCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 GLENPARK LN
MIDLOTHIAN VA
23114-3068
US

IV. Provider business mailing address

507 GLENPARK LN
MIDLOTHIAN VA
23114-3068
US

V. Phone/Fax

Practice location:
  • Phone: 804-517-0766
  • Fax:
Mailing address:
  • Phone: 804-517-0766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateVA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: