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Provider Information for 1194023168


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Ms. KIM VICTORIA TAYLOR LCAS


Sex: Female

NPI: 1194023168
Last Updated: 2024-09-26
Certification Date: 2024-09-26

Details

NameValue
NPI1194023168
Enumeration Date2011-03-01
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address 109 CAMBRIDGE PL
SMITHFIELD, NC 27577-4717
United States

Phone: 919-989-8114 | Fax:919-938-0503
 
Primary Practice Address 109 CAMBRIDGE PL
SMITHFIELD, NC 27577-4717
United States

Phone: 919-989-8114 | Fax:919-938-0503
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 1041C0700X - Social Worker - ClinicalNCP-005960
Yes 101YA0400X - Counselor - Addiction (Substance Use Disorder)NC1774