Healthcare Provider Details

I. General information

NPI: 1427042530
Provider Name (Legal Business Name): LAURA ASHLEY TAYLOR PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 MONUMENT AVE STE A
RICHMOND VA
23226-1452
US

IV. Provider business mailing address

PO BOX 18246
RICHMOND VA
23226-8246
US

V. Phone/Fax

Practice location:
  • Phone: 804-983-8406
  • Fax: 804-508-6613
Mailing address:
  • Phone: 804-398-8406
  • Fax: 804-508-6613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number0810003523
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810003523
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: