Healthcare Provider Details

I. General information

NPI: 1831039569
Provider Name (Legal Business Name): TAYLOR MARIE DEAL LAPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 CUMBERLAND PKWY SE
ATLANTA GA
30339-4515
US

IV. Provider business mailing address

905 COVE PL
ATLANTA GA
30339-5210
US

V. Phone/Fax

Practice location:
  • Phone: 912-590-2452
  • Fax:
Mailing address:
  • Phone: 912-590-2452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPC009759
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: