| Doctor Name: | TAYLOR NICOLE SELF |
| NPI Number: | 1093185795 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSWA |
| License Number: | P010089 |
| Business Practice Address: | 179 W Main St Suite 132 Forest City, NC - 280433076 |
| Business Phone Number: | 8282484403 |
| Business Fax Number: | 7044874005 |
| Mailing Address: | 179 W Main St, Suite 132 FOREST CITY |
| State: | NC |
| Postal Code: | 280433076 |
| Phone Number: | 8284299906 |
| Fax Number: | 7044874005 |
| NPI Enumeration Date: | 10/07/2015 |
| NPI Last Update Date: | 10/07/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | P010089 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |