Provider Demographics
NPI:1033757547
Name:TAYLOR, SHANNA MICHELE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:SHANNA
Middle Name:MICHELE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MISS
Other - First Name:SHANNA
Other - Middle Name:MICHELE
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1258 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:SOPERTON
Mailing Address - State:GA
Mailing Address - Zip Code:30457-3500
Mailing Address - Country:US
Mailing Address - Phone:478-202-3206
Mailing Address - Fax:
Practice Address - Street 1:1258 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:SOPERTON
Practice Address - State:GA
Practice Address - Zip Code:30457-3500
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW008788104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty