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General NPI Number Information
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NPI Number | 1174266985
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Entity Type | Individual
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Provider Name | CHARMION LYNELL TAYLOR
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Gender | Female
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Dates
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Enumeration Date | 04/19/2022
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Last Update Date | 10/31/2023
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Provider Practice Location Address
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Address Line | 760 LONGLEAF BLVD STE B
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-8458
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Country | US
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Telephone | 678-376-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 1017 FAYETTEVILLE RD SE STE A
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City | ATLANTA
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State | GA
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Zip | 30316-2932
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC014101
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 006480
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License Number State | GA
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