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General NPI Number Information
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NPI Number | 1962202838
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Entity Type | Individual
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Provider Name | TAYLOR ASHLEY JACQUETTE LPC
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Gender | Female
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Dates
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Enumeration Date | 03/18/2025
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 6340 CENTER DR STE 100
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City | NORFOLK
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State | VA
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Zip | 23502-0008
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Country | US
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Telephone | 703-466-5150
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Fax |
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Provider Business Mailing Address
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Address Line | 1406 MELROSE PKWY
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City | NORFOLK
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State | VA
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Zip | 23508-1706
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Country | US
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Telephone | 757-753-6957
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0701014652
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License Number State | VA
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