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General NPI Number Information
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NPI Number | 1255656039
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Entity Type | Individual
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Provider Name | NIEFA ANTOINETTE TAYLOR LPC
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Gender | Female
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Dates
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Enumeration Date | 04/05/2010
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Last Update Date | 04/11/2011
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Provider Practice Location Address
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Address Line | 165 BURKE ST SUITE 109
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-3463
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Country | US
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Telephone | 404-563-5189
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Fax | 678-623-3748
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Provider Business Mailing Address
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Address Line | 165 BURKE ST SUITE 109
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-3463
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Country | US
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Telephone | 404-563-5189
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Fax | 678-623-3748
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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 | LPC 006345
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License Number State | GA
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