Provider Demographics
NPI:1871809038
Name:TAYLOR, CARLA MARIE (CADC II, AMFT)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:MARIE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CADC II, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5121 REYNOLDS ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92114-6239
Mailing Address - Country:US
Mailing Address - Phone:619-844-9094
Mailing Address - Fax:
Practice Address - Street 1:4660 EL CAJON BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-4450
Practice Address - Country:US
Practice Address - Phone:619-597-7335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-26
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106574106H00000X
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)