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General NPI Number Information
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NPI Number | 1255059002
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Entity Type | Individual
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Provider Name | TAYLOR THOMPSON
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Gender | Female
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Dates
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Enumeration Date | 08/18/2022
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Last Update Date | 08/18/2022
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Provider Practice Location Address
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Address Line | 304 ARLINGTON DR
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City | VIDALIA
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State | GA
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Zip | 30474-8935
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Country | US
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Telephone | 912-537-1414
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Fax |
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Provider Business Mailing Address
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Address Line | 2226 US HIGHWAY 221
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City | SOPERTON
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State | GA
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Zip | 30457-3322
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Country | US
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Telephone | 912-326-3526
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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