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General NPI Number Information
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NPI Number | 1962103275
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Entity Type | Individual
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Provider Name | TAI DYER
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Gender | Female
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Dates
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Enumeration Date | 03/14/2023
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Last Update Date | 08/17/2023
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Provider Practice Location Address
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Address Line | 213 HARWELL PL NW APT B
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City | ATLANTA
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State | GA
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Zip | 30318-5811
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Country | US
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Telephone | 678-631-8233
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Fax |
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Provider Business Mailing Address
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Address Line | 8090 ADAIR LN
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City | SANDY SPRINGS
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State | GA
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Zip | 30350-3933
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Country | US
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Telephone | 305-767-6638
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | APC008472
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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 | LPC014089
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License Number State | GA
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