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Provider Information for 1780090399


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MARTIA TAYLOR LCMHC, LCAS


Other Names:  
Former Name: 
MARTIA KENNEDY LCMHC, LCAS

Sex: Female

NPI: 1780090399
Last Updated: 2024-05-20
Certification Date: 2024-05-20

Details

NameValue
NPI1780090399
Enumeration Date2014-07-02
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
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:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 101YM0800X - Counselor - Mental Health
Yes 101Y00000X - Counselor
No 101YA0400X - Counselor - Addiction (Substance Use Disorder)