Provider Demographics
NPI:1366408718
Name:TAYLOR, DEBORAH JEAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:JEAN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 RANDALL PARKWAY
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-2829
Mailing Address - Country:US
Mailing Address - Phone:910-791-5719
Mailing Address - Fax:910-799-8180
Practice Address - Street 1:15444 US HWY. 17 N
Practice Address - Street 2:BLDG. 16
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-8250
Practice Address - Country:US
Practice Address - Phone:910-270-5505
Practice Address - Fax:910-270-5496
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2791103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000851Medicaid
NC2821014Medicare PIN