| Doctor Name: | MS. CHONTAY DETRIA TAYLOR |
| NPI Number: | 1164631727 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSN, RN, PMHNP-BC |
| License Number: | 4704208682 |
| Business Practice Address: | 1404 Aline Dr Grosse Pointe Woods, MI - 482361062 |
| Business Phone Number: | 3134596707 |
| Business Fax Number: | 3134587330 |
| Mailing Address: | 1404 Aline Dr, GROSSE POINTE WOODS |
| State: | MI |
| Postal Code: | 482361062 |
| Phone Number: | 3134596707 |
| Fax Number: | 3134587330 |
| NPI Enumeration Date: | 05/21/2007 |
| NPI Last Update Date: | 12/05/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WC1500X |
| License Number: | 4704208682 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MI |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Community Health |
| Taxonomy Definition: | |