Healthcare Provider Details

I. General information

NPI: 1144136763
Provider Name (Legal Business Name): TAYLER LEANN WILSON LPC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2026
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 HIGHWAY 81 N
ANDERSON SC
29621-3620
US

IV. Provider business mailing address

220 FIELDSTONE DR
MOUNT AIRY GA
30563-2841
US

V. Phone/Fax

Practice location:
  • Phone: 864-224-5450
  • Fax:
Mailing address:
  • Phone: 540-633-8083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11127
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: