Individual
CHARLIE RANDOLPH TAYLOR JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, LCASA
Contact information
Practice address
517 CLANTON ROAD, CHARLOTTE, NC 28217
(704) 332-9001
Mailing address
515 CLANTON RD, CHARLOTTE, NC 28217-1309
(704) 332-9001
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
22826
NC
Other
Enumeration date
02/20/2017
Last updated
02/20/2017
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