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General NPI Number Information
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NPI Number | 1770172421
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Entity Type | Individual
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Provider Name | TAYLAR JACKSON LOVELESS MED, LPC, NCC
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Gender | Female
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Dates
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Enumeration Date | 01/15/2021
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Last Update Date | 10/23/2025
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Provider Practice Location Address
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Address Line | 231 RIVER PARK NORTH DR
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City | WOODSTOCK
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State | GA
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Zip | 30188-7835
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Country | US
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Telephone | 770-464-6106
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Fax |
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Provider Business Mailing Address
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Address Line | 209 CARRINGTON WAY
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City | CANTON
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State | GA
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Zip | 30115-4721
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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 | LPC014476
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License Number State | GA
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