Charlie Randolph Taylor Jr., MA, LCASA

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

22826 Issued in NC

Practice address

517 Clanton Road
Charlotte, NC 28217

Phone

(704) 332-9001

NPI assigned

Feb 20, 2017

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mindful Movements, PLLC

  • Community/Behavioral Health Agency
  • Matthews, NC
  • NPI 1205392099
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1487548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487548800000",
    "number": "1619416906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 CLANTON RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282171309",
            "telephone_number": "704-332-9001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "517 CLANTON ROAD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28217",
            "telephone_number": "704-332-9001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAYLOR",
        "first_name": "CHARLIE",
        "middle_name": "RANDOLPH",
        "name_suffix": "Jr.",
        "credential": "MA, LCASA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-02-20",
        "last_updated": "2017-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "22826",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashlei Tatyana Taylor
• Austin Turner Taylor, M.ED. CCC-SLP
• Bernita E. Taylor, LCSW
• Brett Taylor, ATC
• Caitlin Pratt Taylor, NP
• Christina Taylor, LPCA
• Curtis Dwayne Taylor
• Cyrita Jai Taylor, MD
• Daphanie Taylor, MD
• David Franklin Taylor, PHARMD

• Addiction (Substance Use Disorder) Counselor in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Addiction (Substance Use Disorder) Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.