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General NPI Number Information
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NPI Number | 1427357045
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Entity Type | Individual
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Provider Name | TANYA ALEXIS TAYLOR LICSW
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Gender | Female
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Dates
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Enumeration Date | 03/22/2011
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Last Update Date | 03/22/2011
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Provider Practice Location Address
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Address Line | 2307 MARTIN LUTHER KING JR AVE SE
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City | WASHINGTON
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State | DC
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Zip | 20020-5813
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Country | US
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Telephone | 202-525-4855
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Fax |
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Provider Business Mailing Address
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Address Line | 11012 SPRING LAKE DR
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City | MITCHELLVILLE
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State | MD
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Zip | 20721-2924
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Country | US
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Telephone | 301-808-6840
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | LC50078571
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License Number State | DC
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