MEDICARE: SAMANTHA LEANN TAYLOR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	20999A	NC

General Provider Information

NPI Number	:	1164368122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA LEANN TAYLOR

Provider Business Mailing Address
First Line	:	4117 PARK RD # 11288
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-2214
Country	:	US
Telephone Number	:	704-258-1432
Fax Number	:

Provider Business Practice Location Address
First Line	:	4117 PARK RD # 11288
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-2214
Country	:	US
Telephone Number	:	704-258-1432
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2026
Last Update Date	:	04/23/2026

Similar Medicare Providers

1518420884 — CATHERINE FORD LCMHC, LCAS
Practice Location Address:

4117 PARK RD
CHARLOTTE, NC
28209-2214

Practice Phone: 704-993-6808
Practice Fax:

1285078642 — DANIELLE HUGHES LCMHC
Practice Location Address:

4117 PARK ROAD, #11511
CHARLOTTE, NC
28209-2214

Practice Phone: 704-312-0686
Practice Fax:

1750149571 — DIVINE WISDOM CARE INC
Practice Location Address:

301 S MCDOWELL ST STE 125-2214
CHARLOTTE, NC
28204-2623

Practice Phone: 980-413-6831
Practice Fax:

1851079461 — DR. GARY DAVID WOLFE III
Practice Location Address:

1601 ABBEY PL STE 220
CHARLOTTE, NC
28209-3825

Practice Phone: 704-512-2110
Practice Fax:

1497697668 — ILYASAH JA'KILLA THOMAS LCMHCA
Practice Location Address:

5821 FAIRVIEW RD STE 101
CHARLOTTE, NC
28209-5601

Practice Phone: 980-308-4500
Practice Fax: 980-458-6037

1639713761 — ELIZABETH HEIDER OTD,OTR/L
Practice Location Address:

4012 PARK RD
CHARLOTTE, NC
28209-2377

Practice Phone: 704-332-4834
Practice Fax:

Directions to “ SAMANTHA LEANN TAYLOR ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.