Provider Demographics
NPI:1871350959
Name:TAYLOR, ANWAR (LMFT-R)
Entity type:Individual
Prefix:
First Name:ANWAR
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:LMFT-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9401 HERSCH FARM LN
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20112-5828
Mailing Address - Country:US
Mailing Address - Phone:301-832-1439
Mailing Address - Fax:
Practice Address - Street 1:12751 MARBLESTONE DR STE 200
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-8337
Practice Address - Country:US
Practice Address - Phone:703-878-3290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0730000730106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist