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General NPI Number Information
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NPI Number | 1376362632
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Entity Type | Organization
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Legal Business Name | TAYLORED MINDS THERAPY PLLC
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Dates
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Enumeration Date | 10/04/2024
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Last Update Date | 10/04/2024
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Provider Practice Location Address
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Address Line | 5306 SIX FORKS RD STE 107
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City | RALEIGH
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State | NC
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Zip | 27609-4468
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Country | US
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Telephone | 919-798-3997
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Fax |
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Provider Business Mailing Address
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Address Line | 2403 KASOTA LN
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City | RALEIGH
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State | NC
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Zip | 27610-7197
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Country | US
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Telephone | 919-798-3997
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DONNITA JENEEN TAYLOR
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Credential | LCSW
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Telephone | 919-798-3997
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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