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General NPI Number Information
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NPI Number | 1629696877
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Entity Type | Individual
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Provider Name | TAYLOR THARP LISW-S, LICDC
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Gender | Female
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Dates
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Enumeration Date | 07/13/2020
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Last Update Date | 07/13/2020
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Provider Practice Location Address
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Address Line | 2710 BILLINGSLEY RD
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City | COLUMBUS
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State | OH
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Zip | 43235-5978
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Country | US
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Telephone | 614-738-8646
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Fax |
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Provider Business Mailing Address
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Address Line | 10359 HINTON MILL RD
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City | MARYSVILLE
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State | OH
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Zip | 43040-8657
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Country | US
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Telephone | 614-738-8646
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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 | I.1700614-SUPV
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LICDC.161778
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License Number State | OH
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