Provider Information for 1780090399
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MARTIA TAYLOR LCMHC, LCAS
Other Names:Former Name:MARTIA KENNEDY LCMHC, LCASSex: Female
NPI: 1780090399
Last Updated: 2024-05-20
Certification Date: 2024-05-20
Certification Date: 2024-05-20
Details
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NPI | 1780090399 | ||||||||||||||||
Enumeration Date | 2014-07-02 | ||||||||||||||||
NPI Type | NPI-1 Individual | ||||||||||||||||
Sole Proprietor | YES | ||||||||||||||||
Status | Active | ||||||||||||||||
Mailing Address | 3168 FOX RUN CIR KINSTON, NC 28504-7548 United States Phone: | Fax: | ||||||||||||||||
Primary Practice Address | 1008 KINGOLD BLVD SNOW HILL, NC 28580-1617 United States Phone: 252-525-0793 | Fax: | ||||||||||||||||
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