Individual
MARTINA D TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
4912 W BROAD ST, RICHMOND, VA 23230-3126
(804) 313-6767
Mailing address
2509 FARRAND ST, HENRICO, VA 23231-3126
(757) 681-4044
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0701013712
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0704014207
VA DEPT HEALTH PROFESSIONALS
VA
Enumeration date
08/24/2021
Last updated
09/05/2024
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