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General NPI Number Information
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NPI Number | 1750051447
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Entity Type | Individual
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Provider Name | TAYLO MARIAH HARRISON
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Gender | Female
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Dates
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Enumeration Date | 09/15/2021
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Last Update Date | 09/15/2021
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Provider Practice Location Address
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Address Line | 20 W BANK ST
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City | PETERSBURG
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State | VA
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Zip | 23803-3279
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Country | US
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Telephone | 804-862-8002
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Fax |
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Provider Business Mailing Address
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Address Line | 7741 BRINK RD
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City | EMPORIA
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State | VA
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Zip | 23847-5311
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Country | US
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Telephone | 434-632-1697
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 09030003307
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License Number State | VA
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