Provider Demographics
NPI:1548833700
Name:TROTTER, TAYLOR (LISW-CP)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:TROTTER
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:MCCORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:879 NE MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-2055
Mailing Address - Country:US
Mailing Address - Phone:648-605-1449
Mailing Address - Fax:
Practice Address - Street 1:879 NE MAIN ST
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-2055
Practice Address - Country:US
Practice Address - Phone:864-605-1449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-23
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
SC181131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC301100Medicaid