MEDICARE: VICTORIA TAYLOR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	APC002711	GA
2	101YP2500X	Professional Counselor	LPC008236	GA

General Provider Information

NPI Number	:	1508135674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA TAYLOR

Provider Business Mailing Address
First Line	:	2801 BUFORD HWY NE STE 195
Second Line	:
City	:	BROOKHAVEN
State	:	GA
Zip	:	30329-2124
Country	:	US
Telephone Number	:	770-284-1044
Fax Number	:	404-288-3860

Provider Business Practice Location Address
First Line	:	2801 BUFORD HWY NE STE 195
Second Line	:
City	:	BROOKHAVEN
State	:	GA
Zip	:	30329-2124
Country	:	US
Telephone Number	:	770-284-1044
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2011
Last Update Date	:	03/11/2021

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Directions to “ VICTORIA TAYLOR ” Practice Location

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