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General NPI Number Information
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NPI Number | 1396973988
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Entity Type | Individual
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Provider Name | LISA D TAYLOR PHD, TLP, LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/23/2009
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | 652 PO BOX
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City | AVONDALE ESTATES
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State | GA
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Zip | 30002
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Country | US
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Telephone | 678-517-9984
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 652
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City | AVONDALE ESTATES
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State | GA
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Zip | 30002-0652
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Country | US
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Telephone | 678-517-9984
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Fax | 404-292-9424
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW003493
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801084326
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6362009715
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | 400719
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License Number State | GA
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